Patients were placed in the lateral decubitus position. A tourniquet was used in all cases. The elbow was exposed via a posterior incision, and a global approach was followed. The ulnar nerve was routinely identified, released from the tunnel, and protected. Broad medial and lateral full-thickness soft tissue flaps were elevated, and the elbow joint was exposed. The coronoid process fracture was addressed first, according to the Regan-Morrey classification.8 (link) Fixation of the coronoid process was performed for type II and III fractures, while type I coronoid tip fractures did not require fixation. The radial head fracture was then repaired or replaced with an artificial implant according to the fracture pattern and bone quality.
Once bony reconstruction was complete, we used a Kirschner-wire (K-wire) to drill a tunnel under the guidance of an aim-device (cruciate ligament reconstruction guide) from the lateral aspect into the distal humerus along the rotation axis of the ulnohumeral joint. The rotation axis could be determined by direct visualizing of the anatomic center of the capitellum and the origin of the medial collateral ligament (MCL). After the tunnel was created, the lateral collateral ligament (LCL) complex injury was repaired by direct suture or reattached to the lateral epicondyle. Most LCL injuries presented as an avulsion fracture over the lateral epicondyle. Anatomical fixation of the LCL could be fulfilled through reattaching the avulsion fragment back to the fracture site using one or two anchor sutures. The MCL complex was not repaired whether residual elbow instability existed or not.
Subsequently, an IJS, as described by Orbay et al, was prepared.6 (link) The IJS was created from a 2.4 mm K-wire with a figure-of-eight formed first on the blunt end to accept two 3.5 mm screws and washers for attachment to the ulna. The axis portion was established by making a sharp bend at the proper location and then cut to the appropriate length. The IJS was applied and attached to the proximal ulna with two 3.5 mm screws and washers while the elbow was in 90 flexion with an anatomic concentric reduction position. Restoration of elbow flexion/extension, pronation/supination, and stability in all directions were assessed under fluoroscopic guidance before wound closure.
Once bony reconstruction was complete, we used a Kirschner-wire (K-wire) to drill a tunnel under the guidance of an aim-device (cruciate ligament reconstruction guide) from the lateral aspect into the distal humerus along the rotation axis of the ulnohumeral joint. The rotation axis could be determined by direct visualizing of the anatomic center of the capitellum and the origin of the medial collateral ligament (MCL). After the tunnel was created, the lateral collateral ligament (LCL) complex injury was repaired by direct suture or reattached to the lateral epicondyle. Most LCL injuries presented as an avulsion fracture over the lateral epicondyle. Anatomical fixation of the LCL could be fulfilled through reattaching the avulsion fragment back to the fracture site using one or two anchor sutures. The MCL complex was not repaired whether residual elbow instability existed or not.
Subsequently, an IJS, as described by Orbay et al, was prepared.6 (link) The IJS was created from a 2.4 mm K-wire with a figure-of-eight formed first on the blunt end to accept two 3.5 mm screws and washers for attachment to the ulna. The axis portion was established by making a sharp bend at the proper location and then cut to the appropriate length. The IJS was applied and attached to the proximal ulna with two 3.5 mm screws and washers while the elbow was in 90 flexion with an anatomic concentric reduction position. Restoration of elbow flexion/extension, pronation/supination, and stability in all directions were assessed under fluoroscopic guidance before wound closure.
