Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table.

Anatomical surgical approach:  A longitudinal incision was made along the flexor carpi ulnaris. The flexor carpi ulnaris muscle was split, and the ulnar nerve was identified and carefully released. Subperiosteal dissection was performed to expose the coronoid process. Reduction of the fracture was achieved using forceps, and an interfragmentary screw was placed to secure the largest fragment. A 1/4 tubular plate was then applied with screws to provide additional support. Finally, a second percutaneous volar approach was utilized to remove the projectile.

The fracture was highly comminuted with significant anterior displacement, necessitating careful handling of multiple small fragments. The use of an interfragmentary screw provided initial stability to the largest fragment, while the 1/4 tubular plate offered additional support to maintain reduction. The ulnar nerve was meticulously protected throughout the procedure to prevent iatrogenic injury.

Postoperative protocol:   Postoperatively, the patient was advised to avoid weight-bearing activities involving the affected arm for 6 weeks. Passive range of motion exercises were initiated immediately, progressing to active-assisted and active range of motion exercises by week 4. Strengthening exercises were introduced at week 8.

Follow up:   Not specified

Orthopaedic implants used:   - Interfragmentary screw - 1/4 tubular plate with screws