Use of Endobutton for Small Avulsion Fracture of Coronoid in the Terrible Triad of the Elbow: A Case Report

The terrible triad (TT) of the elbow consists of coronoid process (CP) fracture, fracture of the radial head (RH), and posterior dislocation. Although the coronoid is an important anterior stabilizer, it is still unclear how to treat comminuted coronoid fractures. Poor fixation of the CP tends to result in posterolateral instability at the elbow joint and often in chronic instability. The ligamentous injuries also cause instability in elbow dislocations and should be suspected. There are various techniques available for coronoid fracture fixation. In this case report, we want to highlight our experience managing a 47-year-old male with posterior dislocation of the elbow after computed tomography (CT) confirmed that the patient had an RH fracture with an avulsion fracture of the coronoid. This TT of the elbow was managed with the help of an endobutton and a Herbert screw for coronoid avulsion fracture and RH fracture, respectively, through a lateral (Kocher) approach in our tertiary care hospital with satisfactory results. The use of endobutton is recommended in type 1 and type 2 coronoid fractures with no or minimal capsular attachment for good suspensory effect, and it emphasizes the possibility of associated coronoid fracture in case of posterior elbow dislocation. This case report emphasizes the fixation of even small fragments of the coronoid fracture for better stability and early mobilization. Postoperative rehabilitation involved using a hinged brace and early mobilization to avoid a stiff elbow and periodic X-rays to check the heterotopic ossification risk.