Master Tech Ortho Surgery Elbow CH1

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1  Exposures of the Upper Extremity: Humerus, Elbow, Forearm

FIGURE 1B-21 In those instances in which there is also loss of flexion, the triceps is elevated from the posterolateral column and the posterior capsule is also excised. If an osteophyte is present, it is removed with an osteotome.

Pearls/Pitfalls/Comments ●● A periosteal elevator is used to elevate the brachialis muscle off the anterior capsule, which can be safely performed, since the arthrotomy provides accurate spatial orientation from lateral to medial across the joint. Be sure to follow curvature of anterior capsule to avoid drifting into the neurovascular bundle. ●● Special contoured retractors have been designedmaking the soft tissue retractor easier (Fig. 1B-22). ●● If an extensile exposure is anticipated, a posterior skin incision is made. The same deep exposure can be accomplished by extending the posterior lateral skin incision and elevating the lateral skin cutaneous flap.

FIGURE 1B-22 Special retractors (available from Mueller, in two sizes) facilitate exposure and protection of the anterior structures.

Limited Kocher Exposure of the Elbow Indications  Simple excision of the radial head, repair of lateral ulnar collateral ligament. Landmarks  Lateral epicondyle, radial head, interval between anconeus and extensor carpi ulnaris. Position  Supine, arm across the chest. Skin Incision  From the subcutaneous border of the ulna obliquely across the posterolateral aspect of the elbow ending just proximal to the lateral epicondyle (Fig. 1B-23A and B). Note : This is directly over Kocher interval.