Surgical Discussion

Patient positioning:  The patient was positioned supine on a hand table to facilitate access to the elbow structures.

Anatomical surgical approach:  A Kocher approach was utilized, exploiting the lateral soft tissue injury to access the capitellum, coronoid, and radial head. If necessary, surgical destabilization via lateral epicondyle osteotomy or soft tissue takedown was planned to improve access to the capitellum.

The fixation sequence was critical, beginning with the coronoid fracture, which was reduced and stabilized with one screw. The capitellum fracture was repaired using bioabsorbable pins due to its thin structure. The radial head was fixed using lag technique without headless compression screws. An anatomic repair of the LUCL and common extensor origin was performed to stabilize the elbow. Consideration for medial approach to repair the medial ulnar collateral ligament (MUCL) was reserved if instability persisted.

Postoperative protocol:   Postoperative rehabilitation included early mobilization to prevent stiffness, with emphasis on maintaining elbow stability through protected range of motion exercises.

Follow up:   Not specified

Orthopaedic implants used:   Bioabsorbable pins, lag screws