Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with the arm placed on an arm board to allow for optimal access to the volar and lateral aspects of the elbow.

Anatomical surgical approach:  The surgical approach commenced with a volar Henry approach to address the proximal radius fracture. This involved an incision along the volar aspect of the forearm, with careful dissection to expose the radius for fixation. Subsequently, Kaplan's interval was utilized for access to the capitellum fracture due to intraoperative findings of a fascial tent, allowing for direct visualization and fixation of the capitellum.

The surgeon noted the complexity of the case due to the multiple components requiring precise execution for a stable outcome. The sequence of fixation was critical: first addressing the radius, followed by the capitellum, then managing the radial head, and finally addressing ligamentous stability. The radial head replacement posed challenges in terms of implant selection and positioning, particularly in conjunction with the capitellum fracture and elbow instability. The procedure concluded with a stable elbow in full pronation-supination and full extension, which was an unexpected positive outcome given the initial concerns.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with emphasis on maintaining range of motion. Weight-bearing restrictions were applied as necessary, with gradual progression based on clinical assessment.

Follow up:   Not specified.

Orthopaedic implants used:   Radial head prosthesis, internal fixation devices for proximal radius and capitellum fractures (specific implants not detailed).