Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table. The left arm was placed on an auxiliary arm table, allowing for internal and external rotation of the shoulder joint to facilitate access to both medial and lateral aspects of the elbow.

Anatomical surgical approach:  A lateral approach was initiated with an incision over the capitulum and radial head, proceeding through a muscle-splitting technique via the extensor digitorum communis to access the lateral collateral complex. Subsequently, a medial approach was performed with an incision extending from the medial epicondyle over the proximal forearm, utilizing a muscle-splitting technique between the heads of the flexor carpi ulnaris to expose the sublime tubercle and anteromedial facet.

Examination of the lateral collateral complex revealed no injury, allowing focus on the medial structures. The anteromedial facet was reconstructed using Kirschner wires and stabilized with a coronoid plate. The sublime tubercle fragment was similarly fixed, and a 3.5-mm titanium anchor was used to repair the avulsed medial collateral ligament to the medial epicondyle. Intraoperative fluoroscopy confirmed stable fixation without evidence of instability or intra-articular hardware placement.

Postoperative protocol:   Postoperative rehabilitation will involve encouraging a full active range of motion under non-weight-bearing conditions. A shoulder sling may be used for pain control as needed.

Follow up:   Not specified

Orthopaedic implants used:   Kirschner wires, coronoid plate, 2.0-mm screws, 3.5-mm titanium anchor, fiber wire suture