. Medial approach to the elbow. OrthopaedicsOne Articles. In: OrthopaedicsOne - The Orthopaedic Knowledge Network. Created Mar 04, 2009 02:19. Last modified Apr 28, 2011 13:02 ver.4. Retrieved 2019-04-22, from https://www.orthopaedicsone.com/x/0oEqAQ.
- Open reduction and internal fixation of fractures of the coronoid process of the ulna, of the medial humeral condyle and epicondyle.
- Removal of loose bodies.
- Good exposure of the medial compartment of the joint.
- Can be enlarged to expose the anterior surface of the distal fourth of the humerus.
- Provides poor access to the lateral side of the joint and difficult used for routine exploration of the elbow.
- Dislocating the elbow joint during the procedure to gain access to the lateral side of the elbow, if necessary.
- The ulnar nerve (which runs across the operative field), median nerve, and brachial artery may be at risk in this exposure.
Position of patient
- The patient is placed supine on the operating table, with the arm supported on an arm board over the patient.
- Abduct the arm and rotate the shoulder fully externally so that the medial epicondyle of the humerus faces anteriorly.
- Exsanguinate the limb and then inflate a tourniquet.
Landmarks and incision
- The medial epicondyle of the humerus.
- Curved incision 8 to 10 cm long, centered on the medial epicondyle.
- Between the brachialis (musculocutaneous nerve) and the triceps (radial nerve).
- Between the brachialis(musculocutaneous nerve) and the pronator teres (median nerve).
- Incise the fascia over the ulnar nerve, starting proximal to the medial epicondyle, and isolate the nerve.
- Define the interval between the pronator teres and brachialis muscles, retracting the pronator teres medially and lifting it off the brachialis.
- Osteotomy of the medial epicondyle, reflecting it with its attached common flexor origin distally.
- Superiorly, develop interval between the brachialis, retracting it anteriorly, and the triceps, retracting it posteriorly.
Incise the capsule and the medial collateral ligament to expose the joint.
- Ulnar nerve: Dissected out and isolated along the length of the incision before the medial epicondyle osteotomy.
- Median nerve: Enters the pronator teres near the midline. Aggressive traction on the osteotomy fragment can cause a traction injury to the median and anterior interosseous nerves.
How to enlarge the approach
- Abduction of forearm opens medial aspect of joint.
- Dislocate the joint laterally by dissecting off joint capsule and periosteum, allowing free mobility of the proximal ulna.
- Anterior surface of distal fourth of humerus can be exposed by developing plane between brachialis and triceps by subperiosteal dissection and elevation of the brachialis.
- Limited by the branches of the median nerve.
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