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Background: Terrible triad of the elbow presents a rare combination of posterior elbow dislocation with a radial head fracture and the ulnar coronoid process fracture. Such injuries usually have variable outcomes. Case report: We report the case of a 44-year-old male who presented with a bilateral terrible triad of the elbow, occurring after a fall from height. We performed a surgical fixation of the radial head through a lateral approach on one side and an excision of the fractured fragment on the opposite side. A simultaneous repair of the lateral collateral ligament (LCL), medial collateral ligament (MCL), and coronoid was fixed bilaterally through an anteromedial incision. Three months after surgery, bone union was observed. The patient was able to resume his daily activities after five months of surgery with good functional outcomes. Conclusion: Precise surgical planning and rehabilitation can achieve good functional and clinical outcomes in terrible triad injuries with minimal use of implants.