Surgical Discussion

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

Anatomical surgical approach:  A direct lateral approach was executed via a 2.5 cm incision over the epicondyle, slightly anteriorly. Blunt dissection through the extensor muscle mass exposed the ventrally and distally displaced fragment. Anterior blunt dissection allowed identification of the joint capsule, which was incised over 1.5 cm to visualize the articular surface contour and fracture transition from the capitellum through the trochlea.

The fracture was reduced under direct vision and temporarily stabilized with a 1.6 mm Kirschner wire. Two additional 1.2 mm Kirschner wires were used to guide the placement of 4.0 mm cannulated screws. The first screw was placed transversely across the joint along the elbow axis for articular compression, while the second screw was inserted obliquely in a retrograde manner across to the ulnar column of the distal humerus, avoiding olecranon fossa encroachment and providing multidimensional stability. The wound was irrigated with normal saline, and fluoroscopic evaluation confirmed anatomic reduction. Closure was performed in layers: joint capsule, extensor fascia, subcutaneous tissue, and skin with interrupted sutures.

Postoperative protocol:   Postoperatively, the patient will undergo one week of immobilization in an above-elbow splint, followed by active and passive non-weight-bearing range of motion exercises. Hardware removal is planned at approximately three months.

Follow up:   Not specified.

Orthopaedic implants used:   1.6 mm Kirschner wire, 1.2 mm Kirschner wires, 4.0 mm cannulated screws.