Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected arm extended on an arm board to facilitate access to the upper extremity.

Anatomical surgical approach:  A direct approach to the open wounds was utilized for exploration and debridement. The brachial artery was visualized and confirmed intact with Doppler signals. Both the radial and median nerves were found intact. The ulna was approached through a mini-open incision for reduction and intramedullary nailing. The supracondylar humerus fracture was reduced and stabilized with three lateral Kirschner wires. The radial neck was manipulated and reduced through the existing traumatic wound.

Intraoperative findings confirmed that the brachial artery was intact, allowing restoration of a palpable radial pulse post-reduction. The compartments remained soft throughout the procedure, negating the need for fasciotomy. Post-reduction, the elbow and radial neck were stable through a range of motion. A well-molded splint was applied after wound closure. Postoperative monitoring focused on compartment checks and pain management due to high risk of compartment syndrome. The patient experienced a radial nerve motor neuropraxia, which improved over several months.

Postoperative protocol:   Postoperative care included vigilant monitoring for signs of compartment syndrome, with emphasis on escalating pain medication requirements as an indicator. Rehabilitation involved maintaining immobilization in a splint, with gradual progression to active range of motion exercises as healing permitted.

Follow up:   Not specified

Orthopaedic implants used:   Intramedullary nail for ulna fixation, Kirschner wires for supracondylar humerus fracture stabilization.