Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected arm draped free on a hand table to allow optimal access to the posterior aspect of the distal humerus.

Anatomical surgical approach:  The surgical approach involved utilizing the existing traumatic posterolateral wound to access the lateral column of the distal humerus. A mini open approach was performed at the medial epicondyle to enable secure placement of fixation screws in the medial column.

The surgeon noted that due to the patient's size and limited remodeling potential, achieving a precise reduction and stable fixation was critical. The decision to proceed with ORIF was influenced by the need for direct access to the fracture site and wound management. In a closed fracture scenario, percutaneous pinning might have been considered; however, given the patient's skeletal maturity and fracture characteristics, ORIF was deemed appropriate.

Postoperative protocol:   Postoperatively, the patient was advised to maintain immobilization with a posterior splint for initial wound healing and stabilization. Gradual mobilization exercises were introduced after wound healing, with progression to active range of motion exercises as tolerated.

Follow up:   Not specified

Orthopaedic implants used:   Orthopaedic implants used included cannulated screws for medial and lateral column fixation.