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 both medial and lateral aspects of the elbow.

Anatomical surgical approach:  The medial approach involved identifying and protecting the branches of the antebrachial nerve and the ulnar nerve. The flexor carpi ulnaris (FCU) was split by finding the interval between its ulnar and humeral heads. This provided access to the coronoid base and anteromedial facet fractures.

The coronoid base was reduced first, followed by the anteromedial facet, which had the medial ulnar collateral ligament attached. Fixation was achieved using a 2.0mm T-plate and screws, ensuring no violation of the proximal radioulnar joint (PRUJ). The lateral ulnar collateral ligament (LUCL) had avulsed from its origin at the Kocher interval and was repaired using a suture anchor. Elbow stability was confirmed through a full range of motion, negating the need for additional stabilization methods such as an internal stabilizer or static external fixator.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with active range of motion exercises initiated immediately to prevent stiffness. Weight-bearing restrictions were maintained until radiographic evidence of fracture healing was confirmed.

Follow up:   Not specified.

Orthopaedic implants used:   2.0mm T-plate, screws, suture anchor.