Surgical Discussion

Patient positioning:  The patient was positioned prone on the operating table with the arm supported on a padded arm board to allow optimal access to the posterior aspect of the elbow.

Anatomical surgical approach:  A posterior midline incision was made over the distal humerus. The triceps was split in line with its fibers, providing access to the distal humerus without performing an olecranon osteotomy. Subperiosteal dissection was carried out to expose the fracture site.

The distorted distal humeral morphology presented challenges in achieving stable reduction and fixation. Metaphyseal reads were utilized for fracture reduction due to the absence of articular reads. The absence of the lateral trochlea necessitated alternative fixation strategies, as lag screws across the columns at the articular surface were not feasible.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a posterior splint for 2 weeks, followed by gradual range of motion exercises. Weight-bearing activities were restricted until radiographic evidence of healing was observed.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used: Not specified.