Surgical Discussion

Patient positioning:  The patient was positioned prone on the operating table to facilitate a posterior approach to the elbow.

Anatomical surgical approach:  A posterior midline incision was made over the elbow, extending proximally and distally to allow adequate exposure. An olecranon osteotomy was performed to provide direct access to the distal humerus. The ulnar nerve was identified and carefully decompressed and mobilized. The articular surface of the distal humerus was reduced and temporarily fixed with a screw and Kirschner wires. The distal fragment was then aligned with the proximal humerus using additional Kirschner wires. Definitive fixation was achieved using two orthogonal plates, ensuring stable reconstruction of the distal humerus. The olecranon osteotomy was repaired using a tension band wiring technique.

Intraoperative fluoroscopy confirmed satisfactory reduction and alignment of the fracture fragments. The use of orthogonal plating provided robust stabilization of the distal humerus, allowing for early mobilization postoperatively. The tension band wiring of the olecranon osteotomy ensured secure fixation, minimizing the risk of postoperative displacement.

Postoperative protocol:   Postoperative rehabilitation included early range of motion exercises initiated within the first week to prevent elbow stiffness. Weight-bearing activities were restricted until radiographic evidence of fracture healing was observed.

Follow up:   Not specified.

Orthopaedic implants used:   Orthogonal plates for distal humerus fixation, Kirschner wires, tension band wiring for olecranon osteotomy repair.