Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected arm placed on an arm board to allow for full access to the lateral aspect of the elbow.

Anatomical surgical approach:  A lateral approach to the elbow was utilized, involving an incision over the lateral epicondyle. Dissection proceeded through the subcutaneous tissue to expose the extensor muscle origin, which was elevated to access the radial head and neck. The LUCL was identified and repaired following fixation of the radial head fracture.

The surgeon noted that the radial head fracture required meticulous reconstruction due to its comminuted nature. Threaded K-wires were used for provisional fixation, followed by definitive fixation with 1.5mm and 2.0mm screws. A 1.5mm T-plate was applied to the radial neck as a buttress to enhance stability. The LUCL and common extensor origin were repaired using non-absorbable sutures. Intraoperative assessment of DRUJ stability was performed, and no immediate intervention was required for the wrist.

Postoperative protocol:   Postoperatively, a specific motion protocol was initiated at one week, continuing through week six. An orthoplast splint was applied when not performing exercises to protect the repair while allowing controlled motion.

Follow up:   Not specified.

Orthopaedic implants used:   Threaded K-wires, 1.5mm screws, 2.0mm screws, 1.5mm T-plate.