Master Tech Ortho Surgery Elbow CH1

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

●● The medial intermuscular septum is identified anteriorly and posterior and then released for a distance of about 5 cm proximally (Fig. 1B-62). ●● Locate the medial supracondylar ridge and begin elevating the anterior brachialis muscle with a periosteal elevator. ●● Subperiosteally elevate enough of the anterior structures of the distal humeral region to allow the placement of a wide retractor. The median nerve, brachial artery, and vein are superficial to the brachialis muscle and need not be identified. ●● The flexor pronator muscle mass is divided in line with the fibers of the flexor carpi ulnaris mus- cles, leaving a portion of the flexor carpi ulnaris tendon attached to the epicondyle (Fig. 1B-63). Note : A small cuff of fibrous origin can be left on the supracondylar ridge as the muscle is elevated to facilitate reattachment when closing. ●● The pronator muscle is elevated from the capsule encountering the brachialis muscle that has been mobilized and retracted laterally (Fig. 1B-64). Note : A proximal, transverse incision in the lacertus fibrosis may also be needed to adequately mobilize the brachialis muscle. ●● As the pronator muscle is elevated from the capsule, the entire anterior capsule is exposed (Fig. 1B-65). ●● The anterior capsule is exposed, providing access to the coronoid (Fig. 1B-66). ●● If necessary, the posterior capsule may be exposed by elevating the triceps from its lateral distal humeral attachment (Fig. 1B-67).

FIGURE 1B-62 The dissection is carried to the intramuscular septum, which is released.