Surgical Discussion

Patient positioning:  Supine positioning was utilized for all cases, with the affected arm placed on a radiolucent arm table to facilitate intraoperative imaging and manipulation.

Anatomical surgical approach:  For Case 1, a posterior approach to the elbow was employed, allowing access to the proximal ulna and radiocapitellar joint. Case 2 involved a volar approach to the distal radius. In Case 3, a dual approach was necessary: a volar approach for the radius and a separate incision for the ulna.

In Case 1, despite anatomical reduction of the ulna, persistent instability necessitated LUCL repair to stabilize the elbow. Case 2's DRUJ remained stable post-radius fixation, negating further intervention. In Case 3, significant DRUJ instability post-fixation required cross pinning in neutral pronation/supination using 2.0mm K-wires, left proud for easy retrieval if breakage occurred.

Postoperative protocol:   Postoperative rehabilitation for Case 1 included early mobilization with elbow range of motion exercises while protecting the LUCL repair. Case 2 involved splinting in full supination for six weeks to maintain DRUJ stability. Case 3 required immobilization in neutral rotation with gradual range of motion exercises initiated after wire removal.

Follow up:   Not specified.

Orthopaedic implants used:   Orthopaedic implants used included: - Case 1: Plates and screws for ulna fixation, suture anchors for LUCL repair. - Case 2: Volar locking plate for radius fixation. - Case 3: Plates and screws for both bones, 2.0mm K-wires for DRUJ stabilization.