Surgical Discussion

Patient positioning:  The patient was positioned supine with the affected arm placed on a radiolucent hand table to facilitate intraoperative imaging and manipulation.

Anatomical surgical approach:  A posterior longitudinal incision was made along the proximal ulna. Subperiosteal dissection was performed to expose the fracture site. Careful attention was given to preserving soft tissue attachments and identifying key anatomical landmarks to guide accurate reduction.

The surgeon noted the importance of restoring the PUDA and natural varus bow of the ulna to prevent malalignment of the radiocapitellar joint. The complexity of the proximal ulnar architecture required meticulous attention to detail during reduction. Despite achieving anatomical reduction, vigilance was maintained for potential soft tissue interposition, such as a buttonholed capsule or flipped annular ligament, which could impede joint stability.

Postoperative protocol:   Postoperatively, the patient was placed in a splint with the elbow in 90 degrees of flexion and forearm in neutral rotation. Early passive range of motion exercises were initiated within the first week, with progression to active-assisted exercises by week 3. Weight-bearing restrictions were maintained until radiographic evidence of healing was observed.

Follow up:   Not specified.

Orthopaedic implants used:   Locking compression plate (LCP) for proximal ulna fixation.