Updated: 12/28/2014

Subcutaneous Approach to Ulnar Shaft

Review Topic
  • Indications
    • ORIF of ulnar fractures
    • ulnar osteotomy
    • ulnar lengthening (Kienbock's disease)
    • ulnar shortening (for radial malunion)
    • osteomyelitis and tumors of ulna
Internervous Plane
  • Between
    • ECU  (PIN nerve) 
    • FCU (ulnar nerve) 
  • Anesthesia
    • general
    • supraclavicular/ infraclaviclar or axillary nerve block
  • Position
    • patient supine with arm placed across chest
    • or elbow flexed while surgical assistant holds forearm vertically
  • Tourniquet
    • applied to upper arm
  • Incision
    • palpate subcutaneous ulnar border of ulna
    • make linear longitudinal incision over subcutaneous border of ulna
      • length based on procedure
  • Superficial dissection
    • incise deep fascia in distal incision in line with skin incision
    • divide plane between ECU and FCU
    • dissect down to subcutaneous border of ulna 
      • at middle 1/3 of ulna must divide fibers of ECU to reach bone
  • Deep dissection
    • incise periosteum over ulna
      • perform subperiosteal dissection
    • In the proximal fifth of the ulna, part of triceps insertion must be detached to gain access to the bone

  • Ulnar nerve
    • proximally passes through two heads of FCU
    • travels down forearm under FCU and on top of FDP
    • protect by dissecting FCU subperiosteally
  • Ulnar artery
    • travels down forearm with ulnar nerve 
      • ulnar artery is radial to ulnar nerve
    • protect by dissecting FCU subperiosteally

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