Surgical Discussion

The operation was done supine with the arm flexed at the elbow and rested on an arm support placed above the patients chest. The surgical approach was primarily through Boyd's interval through which reduction of the joint and retrieval of bony fragments was possible. Consistent with preoperative planning it was decided early to sacrifice the radial head and neck which was resected to stable bone. Removal of the radius allowed good visualisation of the coronoid, or rather the location where the coronoid should be. Through this window in combination with a limited Taylor Shamm approach we could stabilise the ulna and olecranon as a single functioning unit. 3 individual fragments were retrieved from the joint which ultimately represented the coronoid. These pieces were reconstructed on the back table using inter fragmentary k wires which were then reintrotuced and reduced into position through an FCU split approach to the medial side. The bony defect anterior to the coronoid process was filled with radial head autograph which provided a buttress to the the articular coronoid fragments. This conglomeration of fragments was then fixed with both a coronoid plate from aptus, together with a poster anterior lag screw wedging the radial head graft into place. Dynamic stability testing under fluoroscopy demonstrated congruent and stable joint two within 10 degrees of full extension. The patient has been lost to follow-up in the post-operative period. I will be trying to contact him in the near future to assess his mid-term clinical outcome.