A universal posterior elbow approach was performed in all cases with lateral and medial fasciocutaneous flap. Initially, an FCU-split approach was performed, after releasing the ulnar nerve, for internal fixation of the coronoid fracture involving the anteromedial facet. An anatomic coronoid plate (Acumed LLC, Hillsboro, OR, USA) was used as a buttress plate for coronoid fixation. Retrograde screws were used if a noncomminuted coronoid fracture was present with good stability after reduction and/or in addition to the coronoid plate to help reduction. Integrity of the anterior band of the medial ulnar collateral ligament was evaluated. If an injury was suspected, it was repaired using a 3.5 Corkscrew suture anchor (Arthrex, Naples, FL, USA). Through the lateral flap, a Kocher approach was then performed to repair lateral ligaments, and if necessary, an open reduction and internal fixation or arthroplasty of the radial head was performed, in the same fashion than in terrible triad. The ulnar nerve was transposed subcutaneously in all cases. Skin closure and immobilization are similar to those described previously for PLRV (Fig. 4).

Posteromedial rotary pattern surgery. (A) Medial approach, ulnar nerve release, for FCU-split, (B) Identify the fracture of coronoid. (C) Reduction of fracture. (D) Fixation with coronoid plate. (E) Lateral Kocher approach, for repair U-LCL. (F) Postoperative x-ray. FCU-split, splint in flexor carpi ulnaris.

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