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The extended medial elbow approach-a cadaveric study.

Bernhard Jost1, Emanuel Benninger1, Johannes B Erhardt1

  • 1Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Switzerland.

Journal of Shoulder and Elbow Surgery
|May 6, 2015
PubMed
Summary

The extended medial elbow approach provides complete exposure of the medial elbow, combining benefits of the over-the-top method with safe distal access to the ulna. This technique respects critical internervous planes, unlike the flexor carpi ulnaris split.

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Area of Science:

  • Orthopedic Surgery
  • Anatomy

Background:

  • Current medial elbow approaches include the flexor carpi ulnaris (FCU) split and the Hotchkiss over-the-top method.
  • These methods have limitations in fully exposing medial elbow structures.

Purpose of the Study:

  • To define an extended medial elbow approach.
  • This approach aims to combine proximal exposure (over-the-top) with complete coronoid and proximal medial ulna visualization.
  • The study also focuses on preserving the internervous plane between the flexor pronator mass and FCU.

Main Methods:

  • A comparative anatomic study involving dissection of 12 fresh frozen cadaveric elbows.
  • The study compared the distal limitation and exposed area of the extended medial elbow approach versus the FCU split.
Keywords:
ElbowHotchkiss over-the-topcoronoid fracturesflexor carpi ulnaris splitsublime tuberclesurgical exposure

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Main Results:

  • Proximal ulna exposure area was similar between the extended medial approach (840 mm²) and FCU split (810 mm²; P = .44).
  • The extended medial approach's distal limit was the posterior recurrent ulnar artery (68 mm from medial epicondyle).
  • The FCU split was limited by the first motor branch to the FCU in 75% of specimens (29 mm from medial epicondyle; P < .001).

Conclusions:

  • The extended medial elbow approach offers a single, comprehensive method for medial elbow exposure.
  • It integrates the advantages of the over-the-top approach with safe distal extension to the medial ulna.
  • This approach respects the internervous plane, unlike the FCU split.