Surgical Discussion

Patient positioning:  The patient was positioned supine with a tourniquet placed on the upper arm, followed by sterile preparation and draping of the operative field. A team timeout was conducted along with the administration of two grams of prophylactic antibiotics.

Anatomical surgical approach:  A curved incision was made over the lateral epicondyle of the humerus extending distally over the radial head. The extensor digitorum communis muscle belly was identified, and its fibers were split to expose the joint capsule. A longitudinal incision of the capsule was made from the level of the capitulum, extending over the radial head into the proximal aspect of the radial neck. Anterior leaf of the capsule was lightly elevated from its insertion on the capitulum to enhance visualization of the anterior aspect of the joint.

After irrigation and hematoma removal, the two displaced fragments were located at the anterior and anteromedial aspects of the radial head. A 4mm osteotome was introduced into the fracture line, aiding in disimpaction and reduction of one fragment. A 2mm K-wire served as a bone tamp for the second fragment's reduction. Temporary fixation with a 0.8mm K-wire preceded the introduction of a single HBS Mini screw, uniting the fragments into a two-fragment construct. A second HBS Mini screw was inserted radially in subchondral bone, crossing the fracture plane at approximately 90 degrees, ensuring stepless articular reduction and stable osteosynthesis. Joint congruency was confirmed through 180 degrees of rotation, with fluoroscopy validating excellent reduction and restoration of articular axis.

Postoperative protocol:   Immediate postoperative protocol allowed for free non-weight bearing range of motion in extension, flexion, supination, and pronation without the need for a splint.

Follow up:   Not specified.

Orthopaedic implants used:   Two HBS Mini screws.