Master Tech Ortho Surgery Elbow CH1

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

FIGURE 1B-33

Mayo-Modified Extensile Kocher Posterior–Lateral Exposure  The Mayo modification of the Kocher approach consists of reflection and release of a portion (25% to 50%) of the triceps attachment from the tip of the olecranon in a fashion similar to that described for the Mayo approach (5). By folding the reflected portion on itself a torsional, flexion force of the ulna facilitated elbow dislocation. If more than 50% of the attachment is released, the triceps must be securely reattached to bone. Further, when the Mayo-modified Kocher release has been performed, the ulnar nerve must be exposed and released as necessary to avoid compression with varus angular forearm manipulation. Indications  More extensile exposure is required than has been obtained with the previous steps. Specifically, this is the exposure of choice for interposition arthroplasty. Technique  The initial exposure is identified to the classic Kocher. It implies that release of the capsule and of lateral collateral ligament has been performed. The modification consists of the manner of releasing the triceps attachment and exposing the distal humerus. FIGURE 1B-34 By releasing the common extensor tendon and the anterior capsule, as well as the triceps and anconeus posteriorly, a varus stress to the elbow allows it to hinge on the medial collateral ligament and flexor pronator group, providing an extensile exposure to the joint.