Master Tech Ortho Surgery Elbow CH1
1 Exposures of the Upper Extremity: Humerus, Elbow, Forearm
Pitfalls Avoid osteotomy in rheumatoid arthritis as the thin olecranon compromises healing if an osteotomy is carried out (2). The transverse osteotomy of McAusland is associated with an approximately 5% nonunion rate (2). Although for fractures the Chevron osteotomy may improve these results and decrease the nonunion rate, I personally have not had the clinical need to osteotomize the olecranon in the last 14 years. Osteotomy should always be avoided if the olecranon is resorbed. FLEXIBLE EXPOSURES OF THE ELBOW The central concept is a focused, for purpose, approach that may be extended based on real-time exposure requirements. The technique is predicated on raising subcutaneous flaps both medial and laterally. Lateral Exposures A limited proximal lateral approach exposes the supracondylar column. A limited distal approach enters Kocher interval and exposes the radial head and the lateral collateral ligament. Connecting the two defines the extensile Kocher exposure (Fig. 1B-17).
The Column Exposure (3) Indications Anterior–posterior capsular release for stiff elbow. Landmarks Lateral epicondyle, the common extensor tendon, the extensor carpi radialis longus, and the anterior capsule. Position Supine, arm across the chest. Skin Incision The skin incision starts over the lateral column 5 cm proximal to the lateral epicondyle and extends distally 2 cm past the epicondyle (Fig. 1B-18).
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