Abstract Objectives: This study is to compare the results of the single posterior elbow approach and the dual lateral and medial elbow approaches in managing the three components of injury of terrible triad injury of the elbow. Patients & Methods: The prospective intervention study was conducted on 44 patients who had terrible elbow triad fracture-dislocation grouped equally into two groups first one managed through posterior elbow approach and the second one managed through dual lateral and medial elbow approaches. Results: Results: the two groups were compared after the operation and one-year follow up there was no difference between the two groups as regards elbow stability but the range of elbow motion, duration of operation were better in a single approach. Ulnar nerve compression symptoms were developed postoperatively in 4 cases in dual approaches. Conclusion: we can obtain better results in managing the terrible elbow triad through the posterior approach than dual approaches. Keywords: terrible triad; elbow instability; posterior approach; dual lateral and medial approach of the elbow.