Dual internal joint stabilizer placement for elbow instability: a case report

Terrible triad elbow injuries are complex fracture–dislocation patterns associated with a high risk of recurrent instability, stiffness, and heterotopic ossification despite surgical fixation. This case describes a 39-year-old female w ho sustained a terrible triad elbow injury in the setting of a traumatic brain injury; initial fixation was performed, but the patient developed recurrent instability. Following multiple fixation episodes a lateral internal joint stabilizer (IJS) was placed . After being lost to follow-up for one year, the patient returned with ulnar neuropathy and severe joint stiffness complicated by heterotopic ossification (HO). Surgical intervention included hardware removal, ulnar nerve decompression, and HO excision, which resulted in gross instability secondary to collateral ligament insufficiency. A medial and lateral IJS construct was used to provide circumferential stabilization of the elbow without the need for soft tissue reconstruction. Postoperatively, the patient demonstrated progressive improvements in range of motion and functional outcomes without evidence of hardware failure. Although device removal was discussed, the patient was satisfied with her outcome and declined further surgical intervention. The patient has now been followed for two years with retained devices and maintains a functional arc of motion. This case represents the first reported use of dual internal joint stabilizers (IJS) for managing complex elbow instability following heterotopic ossification (HO) excision, suggesting that dual IJS placement may serve as a viable alternative when soft tissue reconstruction alone is insufficient.