A, Internal elbow joint stabilizer. B, Terrible triad injury with coronoid deficiency and overstuffed radial head. C, Locating point where axis of elbow flexion-extension exits capitellum using guide. D and E, Using centering guide along curvature of medial trochlear axis of ulnohumeral rotation is identified. Centering guide is pushed against medial trochlear expansion to locate center point (E). Kirschner wire is inserted through guide and advanced into humerus, stopping short of medial cortex (D). F, For optimal congruent reduction, humerus placed in vertical position. With elbow in 90 degrees of flexion, ulna is pressed against humerus. Rotational stress is eliminated by placing hand over mouth. G, Tightening of connecting joints. H, Repaired terrible triad, with elbow full reduced and supported by internal joint stabilizer. Fixation of coronoid graft with compression screws and replacement of overstuffed radial head.