Elbow dislocations can be divided into simple (no associated fracture) and complex (associated fracture) dislocations. Terrible triad injuries were originally described by Hotchkiss as a complex elbow dislocation that include posterolateral elbow dislocation, a radial head, and a coronoid process fracture. The term “terrible” is related to poor outcomes after this injury as recurrent instability and early arthritis. Generally, nonsurgical management has a limited role in the management of terrible triad injuries. Surgical treatment using a standard protocol of coronoid fracture fixation, if possible, radial head fracture fixation or replacement, and lateral ligamentous repair can result in predictable results. A standardized surgical protocol results in good or excellent results when anatomic fixation is performed to achieve elbow stability. Common complications include stiffness, heterotopic bone formation, infection, ulnar neuropathy, persistent instability, nonunion, and malunion. Revision surgery is necessary in 20–25% of cases.