Surgical Discussion

Patient positioning:  The patient was positioned prone for the initial posterior approach to the proximal ulna. For the second stage, the patient was repositioned supine to facilitate the direct anterior approach to the distal humerus.

Anatomical surgical approach:  The initial surgical approach was a posterior incision to expose the proximal ulna, including subperiosteal dissection around the olecranon and anteromedial facet. The second stage involved a direct anterior approach, providing access to the entire anterior distal humeral articular surface and coronoid process.

The surgeon noted that the free anterior distal humeral articular fragments and residual void presented a significant challenge for access and fixation. Initially, there was consideration for cement reconstruction with potential delayed structural osteochondral grafting; however, large fixable fragments were identified intraoperatively. The distal humerus was repaired first due to improved visualization provided by the displaced coronoid. The coronoid was subsequently reduced and fixed with a buttressing plate. The surgeon emphasized the importance of careful preoperative planning and staging of the procedure to ensure accurate reduction and fixation.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with a focus on achieving a functional motion arc. At 6 months postoperatively, the patient demonstrated a stable, pain-free elbow with a motion arc of 10-125 degrees.

Follow up:   Not specified.

Orthopaedic implants used:   Buttressing plate for coronoid fixation.