Surgical Discussion

Patient positioning:  The patient was positioned prone on the operating table to facilitate access to the posterior aspect of the humerus.

Anatomical surgical approach:  A posterior approach to the humerus was performed using the Gerwin technique. The incision was made along the posterior aspect of the arm, allowing for subperiosteal dissection and exposure of the distal humeral shaft. The radial nerve was identified and found to be entrapped within the fracture site, necessitating careful neurolysis.

Intraoperatively, the radial nerve was successfully released from entrapment at the fracture site. Osteosynthesis was achieved using an extra-articular distal humeral plate. A butterfly fragment was stabilized with interfragmentary screws. The surgical field was irrigated, and the skin was closed in layers.

Postoperative protocol:   Postoperative rehabilitation included immobilization of the arm in a functional brace, with gradual initiation of passive range of motion exercises as tolerated. Active range of motion exercises were introduced once fracture healing was confirmed radiographically.

Follow up:   Not specified.

Orthopaedic implants used:   Extra-articular distal humeral plate, interfragmentary screws.