Surgical Discussion

This case was done supine with the arm freely draped, the elbow flexed to 90 degrees with the forearm held by an arm support placed in front of the patients chest. A combination approach of medial paratricipital and lateral paraolecanon was used. Due to to radial involvement of the lateral collateral origin a medial subluxation of the the ulna was possible allowing access for articular reconstruction without osteotomy. A slow and tedious reconstruction of multiple fragments followed with use of absorbable k wires and headless bone screws recreating an articular block. this block was then reconstructed to to the distal humerus and fixed with 90-degree plating. Intraoperatively this construct was stable and offered a free range of motion 0-20-120 degrees. A postoperative CT scan was performed to confirm quality of reduction. Some proximalisation of the jointline axis in the coronal plane may be appreciated however reconstruction of joint congruity is excellent. Clinical follow-up at 6 weeks together with a follow-up CT scan demonstrated unchanged reduction and maintenance of all hardware. unfortunately clinical range of motion had deteriorated to 0-40-50 degrees representing a functional arc only 10 degrees motion. An intensive physiotherapy rehab regime was instituted at this point. Further follow-up is pending