Surgical Discussion

Operative management took place around 1 week post-injury. Initially opening laterally through kaplans interval access across the joint allowed retrieval of small bony fragments out of the ulnohumeral joint. The evolved common origin of the lateral collateral ligament complex from the lateral epicondyle was then fixed with a single suture anchor at the isometric point. Was this provided excellent stability in extension the joint was still gapping in valgus stress. Was perhaps radiologically not impressive it felt sloppy in the hand and so that a second medial approach was opened to inspect and repair are the medial collateral ligament. Upon opening the media side it became evident that an avulsion of the common flexor origin accompanied the medial collateral avulsion. This is nicely demonstrated in the intraoperative photos provided where the common origin can be reflected and both the common flexor mass together with the ulnar nerve and medial collateral ligament can be identified as two discrete anatomical planes. To suture anchors we used to re fix both the medial collateral and common flexor origin. The medial collateral was suited to a single point although it's fibre bundles perhaps deserves more anatomical reconstruction over the length of the medial epicondyle. Dynamic testing of stability under fluoroscopy demonstrated a congruent stable joint two within 10 degrees of full extension.