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The proximal radioulnar joint plays an important role in elbow and forearm movements. Radial head fracture involves about 20% of the elbow fractures, which is most often accompanied by other damage to the soft or bone tissue. Isolated form is about 2% and bilateral form is rare. Most radial head fractures are the result of low energy and falling down with outstretched hands. Heavy sports injuries, high energy trauma and crashes cause a breakdown with displacement and the possibility of further complications.In this article we  reported a woman  nurse with 35 years old whom suffered pain and swelling of both elbows due to simple falling down with outstretched hands. In the clinical examination, there was a bilateral tenderness and swelling of the elbows. Movements were decreased in right side. There was no nerve defect. In the Xray radiography, bilateral radial head fractures, Mason-type 3 at right and type 1 at left elbow were observed. Right elbow treated by open reduction and internal fixation by mini plate and screws and left side treated by conservative method. The patient was discharged with indomethacin 25 mg 3 times a day for 6 weeks and bilateral long arm splint for 5 to 7 days, active movements were begun. Subsequently, the patient was not adviced for physiotherapy. Complete movements of elbow joints were obtained in right side and left side after 8 and 4 weeks due to teratment. Precise clinical examinations and correct radiographs are necessary to diagnose the bilateral radial head fractures. Early diagnosis and proper treatment and, if necessary, physiotherapy leads to proper improvement and acceptable movements and function.

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The terrible triad of the elbow consists of an elbow joint dislocation (ulnohumeroradial and radiocapitellar), a fracture of the radial head or neck, and a fracture of the coronoid process. Since these injuries are highly prone to persistent pain, poor painful functional outcomes, and common complications—including instability, elbow stiffness, and osteoarthritis—their treatment is predominantly surgical to achieve stability and initiate early mobilization. However, non-surgical treatment may occasionally be appropriate in carefully selected, compliant patients under close clinical and radiographic surveillance. The present study reports a case of an unstable terrible triad of the elbow that was initially a candidate for surgery. However, due to the patient's cardiomyopathy, following initial reduction in the operating room, a long arm splint was applied at 100 degrees of flexion because of instability and re-dislocation. The patient was prescribed Indomethacin 25 mg 2–3 times daily, along with Omeprazole. On the first postoperative day, finger movements and isometric contractions of the forearm and arm muscles were instructed. The splint was removed after 2 weeks, and a splint at 90 degrees of elbow flexion stopping proximal to the wrist was applied until the end of the 6th week. Upon observing satisfactory radiographs at a 45 degrees angle, active motion was permitted from full flexion to 45 degrees of flexion. After 4 weeks, following acceptable radiographs at 30 degrees of flexion, motion was allowed from full flexion to 30 degrees of flexion. At the 6-month follow-up, the patient was satisfied and demonstrated healing of the radial neck fracture. The coronoid process fracture healed via fibrous union but remained asymptomatic. There was no evidence of elbow osteoarthritis, ulnar neuropathy, or heterotopic ossification. The patient exhibited a 20 degrees elbow flexion contracture.