Background: The terrible triad of the elbow, which consists of posterior dislocation, radial head fracture, and ulnar coronoid process fracture, presents a complex clinical challenge. Methods: This study investigated the outcomes of various surgical approaches in a smaller cohort of 11 patients, including 4 females and 7 males. Patients were categorized into three groups: Group A received a combined approach involving open reduction and internal fixation via lateral and anterior approaches, paired with injury repair via a medial elbow approach; Group B underwent a single lateral approach; and Group C received a single anterior approach. Surgical efficacy, incision healing, fracture healing time, recovery of elbow joint function, and complications were assessed. Results: In the cohort of eleven patients, Group A (combined approach) demonstrated the highest surgical efficacy, with 45% rated as excellent and 35.5% as good. In group B (single lateral approach), 18.18% rated as excellent and 27.27% as good. Group C (single anterior approach) showed one case as good. Overall, Group A exhibited the highest surgical efficacy. Conclusion: Our study suggests that a combined surgical approach involving the lateral and anterior methods, in conjunction with medial elbow injury repair, offers advantages in terms of reduced surgical duration, decreased complications, and improved patient outcomes.