Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected arm placed on a hand table, allowing for full access to the medial and lateral aspects of the elbow.

Anatomical surgical approach:  A medial approach to the elbow was performed, involving a longitudinal incision over the medial epicondyle. Subperiosteal dissection was carried out to expose the anteromedial coronoid facet. Bone tunnels were created for suture repair of the coronoid tip fracture. ORIF of the anteromedial facet was performed, followed by reinforcement with suture repair of the ulnar collateral ligament (UCL) through additional bone tunnels. The LUCL was repaired via a lateral approach.

The surgeon noted that despite the complex nature of the injury, successful stabilization was achieved without the need for a static external fixator. The coronoid tip was exploited through the anteromedial facet fracture for suture repair, which was not tensioned or tied until all other repairs were completed. Stability of the elbow was confirmed intraoperatively following repair of the LUCL.

Postoperative protocol:   Postoperatively, the patient was placed in a hinged elbow brace allowing for early range of motion exercises. Weight-bearing restrictions were maintained for six weeks, with gradual progression to full weight-bearing as tolerated.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used included screws for ORIF of the anteromedial coronoid facet and suture anchors for ligamentous repairs.