Surgical Discussion

Patient positioning:  The patient was positioned supine with the arm placed on a radiolucent hand table. A sterile tourniquet was applied to the upper arm.

Anatomical surgical approach:  A combined surgical approach was utilized: - For the ulna and radius ORIF, a posterior midline incision was made, extending from the olecranon to the proximal forearm. The triceps muscle was split longitudinally to expose the fracture sites. - For the LCL repair, a lateral approach was used, involving an incision over the lateral epicondyle with careful dissection to identify and repair the ligament. - For the coronoid bone suture and MCL repair, a medial approach was performed. An incision was made over the medial epicondyle, and subperiosteal dissection was carried out to expose the coronoid process and MCL.

During the procedure, it was noted that restoring the ulnar length posed a significant challenge. Initially, the ulna was fixed first, followed by the radius. However, incongruence of the proximal radioulnar and elbow joints was observed. To address this, the ulnar fixation was revised by removing the distal screws and elongating it by one screw hole to achieve proper alignment. This step ensured congruency of both joints.

Postoperative protocol:   Not specified

Follow up:   Not specified

Orthopaedic implants used:   Orthopaedic implants used: - Proximal ulna plate - Proximal radius plate - Screws for ORIF - Suture anchors for LCL and MCL repair Originally posted to Cubitus Mundi by ~B.Sh.A