Olecranon fractures with associated radial head or coronoid injuries, often termed “terrible triad” variants, are complex elbow injuries that pose challenges in both surgical management and functional recovery. These injuries combine bony comminution with potential ligamentous disruption, increasing the risk of instability, stiffness, and post-traumatic arthritis if inadequately addressed. This systematic review evaluated studies reporting on surgical management of such injuries, focusing on functional outcomes, union rates, complications, and rehabilitation strategies. Across included studies, comprehensive surgical treatment comprising open reduction and internal fixation of the olecranon, fixation or replacement of the radial head, and ligamentous repair when indicated. It was associated with high union rates and good to excellent functional recovery. Early intervention and structured postoperative rehabilitation further optimized motion and strength restoration. Complications were generally low and manageable. Despite favorable outcomes, heterogeneity in fracture patterns, surgical techniques, and follow-up durations limits direct comparisons. Standardized, prospective studies are needed to refine surgical strategies and rehabilitation protocols, guiding optimal care for this challenging injury subset and improving long-term elbow function.