Surgical Discussion

Patient positioning:  The patient was positioned supine with a varus creating bump placed under the elbow to facilitate access to anterior structures.

Anatomical surgical approach:  A lateral approach was performed through the Kocher interval, involving an incision between the extensor carpi ulnaris and anconeus muscles. Subperiosteal dissection was carried out to expose the radial head and neck. The annular ligament and LUCL were repaired using suture anchors, and the common extensor origin was reattached to the lateral epicondyle.

The surgeon emphasized the importance of sequence in addressing this inherently unstable injury. The radial head was fixed or replaced based on fracture comminution. The annular ligament was repaired independently before addressing the LUCL with suture anchors at the isometric point. Stability assessment was conducted through various elbow positions to ensure concentric reduction of the radiocapitellar (RC) and ulnohumeral (UH) joints. Any instability detected between 30-90 degrees necessitated revision of the LUCL repair or additional stabilization measures.

Postoperative protocol:   Postoperatively, the elbow was splinted in 90 degrees of flexion with full pronation. Immobilization duration was adjusted based on stability findings, with potential extension if instability was noted between 0-30 degrees.

Follow up:   Not specified.

Orthopaedic implants used:   Suture anchors for ligament repair, radial head prosthesis (if replacement was performed).