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Complex elbow fracture-dislocations typically include ulnohumeral joint dislocation, radial head and coronoid process fractures and ligamentous disruption and are termed a terrible triad injury. In this case report, we describe a mid-60s female patient with a direct posterior elbow dislocation with comminuted radial head and coronoid process fractures combined with an olecranon avulsion fracture without ligamentous disruption. Surgical intervention was indicated to restore elbow stability and extensor mechanism via posterior approach to the elbow. Given radial head and coronoid fracture comminution, radial head arthroplasty was performed, and a radial head fragment was used as an autograft to reconstruct the coronoid process. Subsequently, the olecranon avulsion fracture was addressed via an all-suture repair through osseous tunnels. Surgical reconstruction resulted in a stable elbow without ligamentous repair and a restored extensor mechanism, and by 4 months post-operatively, the patient had regained pain-free functional range of motion and returned to all her daily activities.