Surgical Discussion

Patient positioning:  The patient is positioned supine on the operating table with the affected arm placed on a radiolucent hand table to facilitate intraoperative imaging and access.

Anatomical surgical approach:  A volar (Henry) approach to the radius and a separate dorsal (subcutaneous) approach to the ulna are utilized. The volar approach involves an incision along the radial aspect of the forearm, retracting the flexor muscles to expose the radius. The dorsal approach involves an incision along the ulnar aspect, retracting the extensor muscles to expose the ulna. Subperiosteal dissection is performed to visualize the fracture sites.

The surgeon notes that achieving optimal fixation in the intercalary segment is challenging due to the curvature of the forearm bones. Bending a 3.5mm plate on the flat is performed to conform to the anatomical shape, but a pediatric femur plate is ultimately used for its superior fit. Interfragmentary compression is achieved using lag screws, ensuring absolute stability across the fracture sites.

Postoperative protocol:   Postoperatively, the patient is placed in a removable splint for comfort and protection. Early active range of motion exercises are initiated within the first week to prevent stiffness. Weight-bearing as tolerated is encouraged to facilitate functional recovery, given the patient's polytrauma status.

Follow up:   Not specified

Orthopaedic implants used:   Pediatric femur plate, 3.5mm locking compression plate, lag screws.