Surgical Discussion

Patient positioning:  The patient was positioned supine with the arm on an arm table, facilitating access to the medial side of the elbow.

Anatomical surgical approach:  A curved incision was made over the medial epicondyle, followed by subcutaneous dissection. Upon reflection of the displaced medial epicondyle fragment, a posterolateral dislocation of the ulna was noted. The approach allowed for direct visualization of the fracture, a complete anterior capsule rupture, near-complete rupture of the brachialis muscle, and identification of small osteochondral fragments from the coronoid process.

Intraoperatively, concerns included managing the gross instability of the elbow and addressing multiple soft tissue injuries including the brachialis rupture. The anterior joint capsule was sutured, whilst brachialis was simply passively adapted through joint reduction and closure of the joint capsule. Along with the reattachment of the medial epicondyle fragment using a cannulated screw and K-wire fixation, this was sufficient to restore stability through a complete ROM. The ulnar nerve was identified and preserved throughout the procedure. Despite the complexity of injuries, and loss of medial collateral ligament integrity, a stable elbow joint was achieved.

Postoperative protocol:   Postoperative rehabilitation included immobilization in an above-elbow fibreglass splint for 3 weeks to protect the repair and allow for secondary healing of soft tissue injuries.

Follow up:   Not specified.

Orthopaedic implants used:   retrograde 4.0 mm cannulated screw up the ulnar column, 1.6 mm K-wire in a transcondylar orientation