Medial Elbow Exposure: Modified Taylor-Scham Versus Flexor Carpi Ulnaris-Split

Area of Science:

• Orthopedic Surgery
• Anatomy
• Surgical Approaches

Background:

• Elbow joint anatomy is complex, requiring precise surgical access for effective treatment.
• Coronoid process fractures and medial collateral ligament injuries necessitate clear visualization of the anteromedial structures.
• Minimally invasive surgical techniques aim to improve exposure while minimizing iatrogenic injury.

Purpose of the Study:

• To quantitatively compare the exposure of the coronoid process, anteromedial facet, and anterior band of the medial collateral ligament.
• To evaluate the flexor carpi ulnaris (FCU)-splitting approach against the modified Taylor-Scham approach with ulnar nerve transposition.

Main Methods:

• Thirty surgical approaches were performed on 15 fresh cadavers using a randomized cross-over design.
• Standardized incisions were utilized, and access to key anatomic landmarks was assessed.
• Digital images were analyzed using ImageJ software to calculate the area of osseous exposure.

Main Results:

• Both the Taylor-Scham and FCU-splitting approaches allowed visualization of all key anatomic landmarks.
• The Taylor-Scham approach provided a significantly larger average exposure area (19.5 cm²) compared to the FCU-splitting approach (13.6 cm²; P < 0.0001).
• The FCU-splitting approach's distal exposure was limited by the ulnar nerve and its branches.

Conclusions:

• The Taylor-Scham approach offers a more extensile exposure of the anteromedial coronoid and proximal ulna.
• This approach avoids cross-tensioning of the ulnar nerve, potentially reducing associated complications.
• The findings suggest the Taylor-Scham approach may be advantageous for specific elbow surgeries requiring extensive visualization.