Background: The terrible triad of the elbow posterior dislocation combined with radial head and coronoid process fractures presents significant treatment challenges due to its inherent instability and high complication risk. Early recognition and standardized surgical intervention are critical for restoring function and minimizing disability. Objectives: To evaluate the functional outcomes, complication rates, and patient satisfaction following standardized surgical treatment for the terrible triad of the elbow. Methods: This prospective observational study included 18 patients aged 28–55 years who underwent surgery for the terrible triad injury at a tertiary care center. The surgical interventions included radial head fixation or arthroplasty, coronoid process fixation, and lateral ulnar collateral ligament (LUCL) repair. The functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analog Scale (VAS), range of motion (ROM), and American Shoulder and Elbow Surgeons (ASES) scores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months. The statistical analysis was performed using Wilcoxon signed-rank and Spearman correlation tests. Results: Postoperative MEPS improved significantly from a mean of 41.44 to 90.17 (p < 0.001), and DASH scores decreased from 65.61 to 16.93 (p < 0.001). VAS scores reduced from 7.11 to 2.61, and significant gains were observed in all ROM components. A strong inverse correlation was noted between MEPS and DASH (ρ = −0.998). Complications occurred in two patients (11%), primarily mild stiffness and superficial infection. Overall, 55.5% of patients reported being satisfied or very satisfied with their outcomes, with an average return-to-work time by 3 months. Conclusion: Standardized surgical protocols for terrible triad injuries of the elbow yield excellent functional recovery, improved mobility, and effective pain control. Early intervention, structured rehabilitation, and careful patient selection are essential for optimizing outcomes and minimizing complications. © 2025 Elsevier B.V., All rights reserved.