Access Keys:
Skip to content (Access Key - 0)

Posterolateral approach to the elbow

Introduction

Indications

  • All surgeries to the radial head, including excision of the radial head and prosthetic replacement.

Disadvantage

  • The incision cannot be extended to the upper part of the radial shaft (below the annular ligament), risking damage to the posterior interosseous nerve.

Position of patient

  • The patient is placed supine on the operating table; pronate the forearm and position it over the chest.
  • Inflate a tourniquet after exsanguinating the limb.

Landmarks and incision

Landmarks

  • Lateral humeral epicondyle.
  • At the radial head, palpate the lateral humeral epicondyle, moving the fingers 2.5 cm distally until a depression is detected. As the forearm is pronated and supinated, movement of the radial head can be felt.

Incision

  • A 5-cm longitudinal incision based proximally on the lateral humeral epicondyle. This incision follows the skin fold and lies directly over the radial head.

Internervous plane

  • Between the anconeus (radial nerve) and the extensor carpi ulnaris (posterior interosseous nerve).

Superficial dissection

  • The deep fascia incised in line with the skin incision.
  • The interval between the extensor carpi ulnaris and the anconeus identified.
  • Detach part of the superior origin of the anconeus as it arises from the lateral epicondyle of the humerus.

Deep dissection

  • Full pronation of the forearm moves the posterior interosseous nerve away from the operative field.
  • Incise the capsule of the elbow joint longitudinally to reveal the underlying capitulum, the radial head, and the annular ligament.

Dangers

Posterior interosseous nerve

  • Full pronation of the forearm keeps the nerve far from the operative field.
  • The dissection remains proximal to the annular ligament to ensure the safety of the nerve.
  • Place the retractors directly on bone, as the posterior interosseous nerve actually may touch the radial neck.

Radial nerve

  • The elbow joint is opened laterally and not anteriorly, as the radial nerve runs over the front of the anterolateral portion of the elbow capsule.

How to enlarge the approach

The approach cannot be extended in any direction.

Figures

Peer Review

OrthopaedicsOne Peer Review Workflow is an innovative platform that allows the process of peer review to occur right within an OrthopaedicsOne article in an open, transparent and flexible manner. Learn more

Instructions for Authors

Read our Instructions for Authors to learn about contributing or editing articles on OrthopaedicsOne.

Content Partner

Learn about becoming an OrthopaedicsOne Content Partner.

Academic Resources

Resources on Posterolateral approach to the elbow from Pubget.

Error rendering macro 'rss' : The RSS macro is retrieving an HTML page.
Orthopaedic Web Links

Internet resources validated by OrthopaedicWebLinks.com

Related Content

Resources on Posterolateral approach to the elbow and related topics in OrthopaedicsOne spaces.

Page: Kochler lateral approach to ankle (OrthopaedicsOne Articles)
Page: Medial approach to the calcaneus (OrthopaedicsOne Articles)
Page: Lateral approach to the calcaneus (OrthopaedicsOne Articles)
Page: U approach to the calcaneus (OrthopaedicsOne Articles)
Page: Kocher approach to the calcaneus (OrthopaedicsOne Articles)
Page: Medial approach to MTP joint of great toe (OrthopaedicsOne Articles)
Page: Dorsomedial approach to MTP joint of great toe (OrthopaedicsOne Articles)
Page: Approach to MTP joint of lesser toes (OrthopaedicsOne Articles)
Page: Approach to IP joint of the toes (OrthopaedicsOne Articles)
Page: Surgical approaches in a nutshell (OrthopaedicsOne Articles)
Showing first 10 of 61 results