Surgical Discussion

Patient positioning:  The patient is positioned in a lateral decubitus position with the affected arm supported and draped to allow full access to the posterior aspect of the elbow.

Anatomical surgical approach:  A posterior approach to the distal humerus is utilized. A midline incision is made over the posterior aspect of the elbow, extending proximally and distally as needed. The triceps muscle is split in line with its fibers to expose the distal humerus. The synovial pseudoarthrosis is debrided, and alignment is restored. The residual defect is measured, and an osteoperiosteal corticocancellous graft is harvested from the gluteal pillar of the iliac crest, shaped to fit the defect, and fixed in place. The olecranon fossa is recreated using a burr.

The surgeon notes that one of the major concerns in this case is elbow joint arthrofibrosis due to prolonged nonunion. To prevent motion concentration through the nonunion repair, which could be detrimental, a comprehensive 360-degree soft tissue release and debridement around the elbow joint is performed to improve range of motion.

Postoperative protocol:   Postoperative rehabilitation includes early mobilization to prevent stiffness. Passive range of motion exercises are initiated immediately postoperatively, progressing to active-assisted and active range of motion as tolerated. Weight-bearing activities are restricted until radiographic evidence of union is observed.

Follow up:   Not specified

Orthopaedic implants used:   Osteoperiosteal corticocancellous graft from iliac crest