Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table with the left arm placed on an auxiliary table. A tourniquet was applied to the upper aspect of the proximal arm .

Anatomical surgical approach:  A curved incision approximately seven centimeters in length was made over the lateral epicondyle of the elbow, extending into the proximal lateral aspect of the forearm. Subcutaneous dissection and hemostasis were performed, followed by an EDC split approach to expose the radial head and neck. The lateral collateral ligament was retracted posteriorly to visualize and remove multiple fragments of the radial head. Resection of the radial neck was performed using an oscillating saw. A stab incision at the posterior aspect of the ulna allowed insertion of a Kirschner wire (K-wire) under fluoroscopic guidance, followed by drilling and placement of a three-millimeter headless compression screw to stabilize the coronoid fracture.

The radial head was deemed irreparable, necessitating replacement with a prosthesis. Rasping of the proximal radial shaft and trialing with a Zimmer ExploreR shaft and head component ensured appropriate sizing. Final prosthesis implantation was confirmed with fluoroscopy, ensuring optimal joint spacing and stability. A corkscrew titanium anchor was placed at an isometric point on the capitulum for suture refixation of the lateral collateral complex. Range-of-motion testing confirmed stable reduction without subluxation.

Postoperative protocol:   Postoperative rehabilitation included unrestricted range-of-motion exercises without immobilization orthosis.

Follow up:   Not specified

Orthopaedic implants used:   Zimmer ExploreR radial head prosthesis, 3mm headless compression screw, Kirschner wire, Arthrex corkscrew titanium anchor