Surgical Discussion

Patient positioning:  The patient was initially positioned supine for the proximal humerus fixation and forearm procedures. If patient condition allowed, repositioning to a lateral decubitus position was planned for optimal access to the elbow.

Anatomical surgical approach:  The surgical approach to the proximal humerus involved an incision over the deltopectoral interval, with potential extension into the rotator interval for direct visualization of the fracture split in the coronal plane. For the forearm, a standard volar Henry approach was utilized for both-bone fixation. The elbow was accessed via a lateral approach to facilitate reduction and fixation of the Monteggia fracture.

The surgeon emphasized the importance of verifying all debridement and vascular repairs personally, despite previous interventions at another facility. Fixation of the proximal humerus was prioritized to protect the vascular repair, followed by addressing the forearm fractures. The elbow was considered technically challenging due to its multifragmentary nature, necessitating precise reduction for successful radial head alignment.

Postoperative protocol:   Postoperative rehabilitation included immobilization of the upper extremity in a sling for initial protection, with gradual mobilization as tolerated. Emphasis was placed on early passive range of motion exercises to prevent stiffness, with progression to active exercises as healing permitted.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used included locking plates for the proximal humerus and forearm fractures, and a radial head prosthesis or plate fixation for the Monteggia fracture, depending on intraoperative findings.