An anterior "Pucker" sign may be shown as part of a viva question.
It's significance has to be recognised
It's presence suggests that the proximal fragment has penetrated brachialis and the anterior fascia of the elbow
As such reduction may be difficult and the surgeon has to be aware of the possibility of requiring to perfrom an open reduction of the fracture from the front.
A milking maneuver can be performed by manipulating the soft tissue over the fragment to pull the soft tissue away from the proximal fragment rather than simply applying traction on the bones,which may not allow reduction of a buttonholed proximal fragment