Updated: 10/12/2014

Elbow Medial Approach

Topic
Review Topic
0
0
https://upload.orthobullets.com/topic/12006/images/1.jpg
https://upload.orthobullets.com/topic/12006/images/1th.jpg
https://upload.orthobullets.com/topic/12006/images/2.jpg
https://upload.orthobullets.com/topic/12006/images/2th.jpg
https://upload.orthobullets.com/topic/12006/images/3.jpg
https://upload.orthobullets.com/topic/12006/images/3th.jpg
Introduction
  • Indications
    • decompression and/or transposition of the ulnar nerve.
    • Ulnar removal of loose bodies
    • ORIF of the ulnar coronoid process
    • ORIF of the medial humeral condyle and epicondyle
    • debridement and reattachment of common flexor wad for medial epicondylitis
    
Internervous plane
  • Proximally between
    • brachialis  (musculocutaneous nerve)
    • triceps  (radial nerve)
  • Distally between
    • brachialis (musculocutaneous nerve)
    • pronator teres  (median nerve)
   
Preparation
  • Anesthesia
    • general
    • supraclavicular or infraclaviclar nerve block
  • Position
    • supine
      • with arm flexed and supported by arm board over the patient
  • Tourniquet
    • applied to upper arm
 
Approach
  • Incision
    • curved incision 8 to 10 cm long on the medial aspect of the elbow
      • centered over the medial epicondyle
  • Superficial dissection
    • incise the fascia over the ulnar nerve starting proximally
      • isolate nerve along the entire length of the incision
    • expose the common flexor origin on the medial epicondyle
    • develop brachialis and PT interval
    • avoid the median nerve which enters PT near the midline
    • if necessary can perform osteotomy of the medial epicondyle
      • osteotomy is reflected distally
      • ensure retained MCL ligament into osteotomy fragment
    • develop brachialis and triceps interval
  • Deep dissection
    • incise capsule and medial collateral ligament
  • Extension
    • local
      • abduction of forearm opens medial aspect of joint
      • can dislocate laterally by dissecting off joint capsule and periosteum
    • proximal
      • anterior surface of distal fourth of humerus can be exposed by developing plane between brachialis and triceps
    • distal
      • limited by the branches of the median nerve
 




Dangers
  • Ulnar nerve
    • is at risk during approach
    • must be dissected out to ensure protection
  • Median nerve
    • aggressive traction on the osteotomy fragment can cause a traction injury to the median and anterior interosseous nerves
 


 

Please rate topic.

Average 3.8 of 9 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
ARTICLES (3)
Topic COMMENTS (5)
Private Note