Background: The term "terrible triad" of the elbow represents an especially challenging combination of injuries: elbow dislocation associated with fractures of the radial head and coronoid process [1]. This case represents a rather rare and technically demanding condition, and adding to it a concomitant humeral shaft fracture and arm compartment syndrome further complicates it [2]. The management had a stepwise surgical plan that included urgent decompression and temporary external fixation all the way to definitive internal fixation, radial head replacement, and ligament reconstructions. It is in such cases where the importance of timely surgical intervention, early identification of nerve injuries, and methodical rehabilitation is highlighted [3]. Case Presentation: A 59-year-old male patient presented to the hospital after a high-impact motor vehicle collision, suffering severe trauma to his right upper extremity. Examination revealed a midshaft humeral fracture, posteriorly dislocated elbow and radial head fracture, and acoronoid tip fracture-a triad of injury known as the terrible triad of the elbow. He was also noted to have clinical findings consistent with compartment syndrome and had preoperative evidence of radial nerve neuropraxia. He had three stages of surgery:(1). Emergency fasciotomy with an elbow spanning external fixator for compartment pressure control and initial stabilization. (2). Open reduction and internal fixation by an intramedullary nail for the fracture of the shaft of the humerus. (3)Radial head replacement and ligament repair for functional restoration of elbow stability. Postoperative immobilization later transformed into a hinged elbow brace, accompanied by supervised physiotherapy. Gradually, this patient made excellent improvements regarding elbow mobility and neurovascular status. Conclusion: This case underlines the difficulties of a "terrible triad" elbow injury with the humeral shaft fracture, compartment syndrome and radial nerve neuropraxia. It requires stepwise and careful staging to allow successful outcomes. This article is marked by early decompression of the compartments, solid fixation, careful repair of the ligaments, and close follow-up for recovery of nerves and stability of the joint.