Updated: 12/28/2014

Subcutaneous Approach to Ulnar Shaft

Topic
Review Topic
0
0
https://upload.orthobullets.com/topic/12012/images/Incision_moved.jpg
https://upload.orthobullets.com/topic/12012/images/1th.jpg
https://upload.orthobullets.com/topic/12012/images/2th.jpg
https://upload.orthobullets.com/topic/12012/images/3th.jpg
https://upload.orthobullets.com/topic/12012/images/4th.jpg
https://upload.orthobullets.com/topic/12012/images/5th.jpg
Indications
  • 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) 
 
Preparation
  • 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
   
Approach
  • 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
 


Dangers
  • 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
 

Please rate topic.

Average 3.4 of 10 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?
Topic COMMENTS (6)
Private Note