Surgical Discussion

Patient positioning:  The patient was positioned prone on the operating table to facilitate a posterior approach to the elbow.

Anatomical surgical approach:  A standard midline posterior approach was employed, involving an incision through the triceps fascia, olecranon, and subcutaneous border of the ulna. A large subcutaneous flap was raised medially, followed by complete neurolysis of the ulnar nerve from the triceps into the two heads of the flexor carpi ulnaris (FCU). The fascia overlying the flexor pronator mass was incised, and the natural raphe was bluntly dissected to reach the proximal anteromedial ulna. Care was taken to preserve crossing branches of the ulnar motor nerve. The midline approach allowed for lateral subcutaneous flap elevation to access Kaplan or Kocher intervals for LUCL or radial head intervention as needed.

Intraoperatively, both the coronoid base fracture and sublime tubercle fracture were successfully reduced and fixed. The LUCL was repaired using #5 Fiberwire through bone tunnels on the lateral epicondyle. The meticulous protection of the ulnar nerve and preservation of motor nerve branches were critical steps in preventing postoperative complications. The surgical team emphasized the importance of addressing this injury pattern to prevent posteromedial rotatory instability and subsequent joint arthrosis.

Postoperative protocol:   Postoperatively, a structured rehabilitation protocol was initiated, focusing on early mobilization while protecting the repair. Initial immobilization in a hinged elbow brace was followed by gradual range of motion exercises, progressing to strengthening exercises as tolerated.

Follow up:   Not specified.

Orthopaedic implants used:   #5 Fiberwire for LUCL repair.