The extended medial elbow approach—a cadaveric study
Background The two most commonly used approaches to expose medial elbow structures are the flexor carpi ulnaris split and the Hotchkiss over-the-top approach. The aim of this study was to define the extended medial approach to the elbow, featuring advantages of over-the-top (proximal exposure) and a...
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| Veröffentlicht in: | Journal of shoulder and elbow surgery 2015-07, Vol.24 (7), p.1074-1080 |
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| creator | Jost, Bernhard, MD Benninger, Emanuel, MD Erhardt, Johannes B., MD Külling, Fabrice A., MD Zdravkovic, Vilijam, MD Spross, Christian, MD |
| description | Background The two most commonly used approaches to expose medial elbow structures are the flexor carpi ulnaris split and the Hotchkiss over-the-top approach. The aim of this study was to define the extended medial approach to the elbow, featuring advantages of over-the-top (proximal exposure) and additional complete exposure of the coronoid and proximal medial ulna, while respecting the internervous plane between the flexor pronator mass and flexor carpi ulnaris muscle. Methods In this comparative anatomic study, 12 fresh frozen cadaveric elbows were dissected alternately to study the distal limitation and exposed area of the extended medial elbow approach compared with splitting the flexor carpi ulnaris. Results Proximal ulna exposure area was comparable between the extended medial elbow approach (average, 840 mm2 ) and the flexor carpi ulnaris split (average, 810 mm2 ; P = .44). The extended medial approach was limited distally by the posterior recurrent ulnar artery (mean 68 mm from medial epicondyle), whereas the first motor branch for the flexor carpi ulnaris muscle limited the second approach in 75% of the specimens (mean 29 mm from medial epicondyle, P |
| doi_str_mv | 10.1016/j.jse.2015.03.013 |
| format | Article |
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The aim of this study was to define the extended medial approach to the elbow, featuring advantages of over-the-top (proximal exposure) and additional complete exposure of the coronoid and proximal medial ulna, while respecting the internervous plane between the flexor pronator mass and flexor carpi ulnaris muscle. Methods In this comparative anatomic study, 12 fresh frozen cadaveric elbows were dissected alternately to study the distal limitation and exposed area of the extended medial elbow approach compared with splitting the flexor carpi ulnaris. Results Proximal ulna exposure area was comparable between the extended medial elbow approach (average, 840 mm2 ) and the flexor carpi ulnaris split (average, 810 mm2 ; P = .44). The extended medial approach was limited distally by the posterior recurrent ulnar artery (mean 68 mm from medial epicondyle), whereas the first motor branch for the flexor carpi ulnaris muscle limited the second approach in 75% of the specimens (mean 29 mm from medial epicondyle, P < .001). Conclusions The extended medial elbow approach is a single approach allowing full exposure of the medial elbow and combining the advantages of the over-the-top approach with a safe distal extension to the medial ulna. In contrast to the flexor carpi ulnaris split, our approach respects the internervous plane.</description><identifier>ISSN: 1058-2746</identifier><identifier>EISSN: 1532-6500</identifier><identifier>DOI: 10.1016/j.jse.2015.03.013</identifier><identifier>PMID: 25940381</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arm Bones - anatomy & histology ; Arm Bones - surgery ; Cadaver ; coronoid fractures ; Elbow ; Elbow - anatomy & histology ; Elbow - surgery ; Elbow Joint - anatomy & histology ; Elbow Joint - surgery ; Female ; flexor carpi ulnaris split ; Hotchkiss over-the-top ; Humans ; Male ; Muscle, Skeletal - surgery ; Orthopedics ; sublime tubercle ; surgical exposure</subject><ispartof>Journal of shoulder and elbow surgery, 2015-07, Vol.24 (7), p.1074-1080</ispartof><rights>Journal of Shoulder and Elbow Surgery Board of Trustees</rights><rights>2015 Journal of Shoulder and Elbow Surgery Board of Trustees</rights><rights>Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c323t-f2dedae5d382c879e71abe26ec8f4b0a713cc0a85042d9dae329b9d35750f6813</citedby><cites>FETCH-LOGICAL-c323t-f2dedae5d382c879e71abe26ec8f4b0a713cc0a85042d9dae329b9d35750f6813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jse.2015.03.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25940381$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jost, Bernhard, MD</creatorcontrib><creatorcontrib>Benninger, Emanuel, MD</creatorcontrib><creatorcontrib>Erhardt, Johannes B., MD</creatorcontrib><creatorcontrib>Külling, Fabrice A., MD</creatorcontrib><creatorcontrib>Zdravkovic, Vilijam, MD</creatorcontrib><creatorcontrib>Spross, Christian, MD</creatorcontrib><title>The extended medial elbow approach—a cadaveric study</title><title>Journal of shoulder and elbow surgery</title><addtitle>J Shoulder Elbow Surg</addtitle><description>Background The two most commonly used approaches to expose medial elbow structures are the flexor carpi ulnaris split and the Hotchkiss over-the-top approach. The aim of this study was to define the extended medial approach to the elbow, featuring advantages of over-the-top (proximal exposure) and additional complete exposure of the coronoid and proximal medial ulna, while respecting the internervous plane between the flexor pronator mass and flexor carpi ulnaris muscle. Methods In this comparative anatomic study, 12 fresh frozen cadaveric elbows were dissected alternately to study the distal limitation and exposed area of the extended medial elbow approach compared with splitting the flexor carpi ulnaris. Results Proximal ulna exposure area was comparable between the extended medial elbow approach (average, 840 mm2 ) and the flexor carpi ulnaris split (average, 810 mm2 ; P = .44). The extended medial approach was limited distally by the posterior recurrent ulnar artery (mean 68 mm from medial epicondyle), whereas the first motor branch for the flexor carpi ulnaris muscle limited the second approach in 75% of the specimens (mean 29 mm from medial epicondyle, P < .001). Conclusions The extended medial elbow approach is a single approach allowing full exposure of the medial elbow and combining the advantages of the over-the-top approach with a safe distal extension to the medial ulna. In contrast to the flexor carpi ulnaris split, our approach respects the internervous plane.</description><subject>Arm Bones - anatomy & histology</subject><subject>Arm Bones - surgery</subject><subject>Cadaver</subject><subject>coronoid fractures</subject><subject>Elbow</subject><subject>Elbow - anatomy & histology</subject><subject>Elbow - surgery</subject><subject>Elbow Joint - anatomy & histology</subject><subject>Elbow Joint - surgery</subject><subject>Female</subject><subject>flexor carpi ulnaris split</subject><subject>Hotchkiss over-the-top</subject><subject>Humans</subject><subject>Male</subject><subject>Muscle, Skeletal - surgery</subject><subject>Orthopedics</subject><subject>sublime tubercle</subject><subject>surgical exposure</subject><issn>1058-2746</issn><issn>1532-6500</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi1UxLaFB-CCcuwlYcZeJ46QKlUVtEiVOFDOlmNPtA7ZZLGTbffGQ_CEPEkdbeHAgdPM4f9_zXw_Y28RCgQs33dFF6nggLIAUQCKF-wUpeB5KQFO0g5S5bxalyt2FmMHAPUa-Cu24jItQuEpK-83lNHjRIMjl23JedNn1DfjQ2Z2uzAau_n985fJrHFmT8HbLE6zO7xmL1vTR3rzPM_Zt08f769v87svN5-vr-5yK7iY8panVEPSCcWtqmqq0DTES7KqXTdgKhTWglES1tzVSSl43dROyEpCWyoU5-zimJtO-TFTnPTWR0t9bwYa56ixVApAIl-keJTaMMYYqNW74LcmHDSCXnDpTidcesGlQeiEK3nePcfPTfr9r-MPnyT4cBRQenLvKehoPQ02cQpkJ-1G_9_4y3_ctveDt6b_TgeK3TiHIdHTqCPXoL8ufS11YaoPRaXEExD9j6s</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Jost, Bernhard, MD</creator><creator>Benninger, Emanuel, MD</creator><creator>Erhardt, Johannes B., MD</creator><creator>Külling, Fabrice A., MD</creator><creator>Zdravkovic, Vilijam, MD</creator><creator>Spross, Christian, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150701</creationdate><title>The extended medial elbow approach—a cadaveric study</title><author>Jost, Bernhard, MD ; Benninger, Emanuel, MD ; Erhardt, Johannes B., MD ; Külling, Fabrice A., MD ; Zdravkovic, Vilijam, MD ; Spross, Christian, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c323t-f2dedae5d382c879e71abe26ec8f4b0a713cc0a85042d9dae329b9d35750f6813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Arm Bones - anatomy & histology</topic><topic>Arm Bones - surgery</topic><topic>Cadaver</topic><topic>coronoid fractures</topic><topic>Elbow</topic><topic>Elbow - anatomy & histology</topic><topic>Elbow - surgery</topic><topic>Elbow Joint - anatomy & histology</topic><topic>Elbow Joint - surgery</topic><topic>Female</topic><topic>flexor carpi ulnaris split</topic><topic>Hotchkiss over-the-top</topic><topic>Humans</topic><topic>Male</topic><topic>Muscle, Skeletal - surgery</topic><topic>Orthopedics</topic><topic>sublime tubercle</topic><topic>surgical exposure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jost, Bernhard, MD</creatorcontrib><creatorcontrib>Benninger, Emanuel, MD</creatorcontrib><creatorcontrib>Erhardt, Johannes B., MD</creatorcontrib><creatorcontrib>Külling, Fabrice A., MD</creatorcontrib><creatorcontrib>Zdravkovic, Vilijam, MD</creatorcontrib><creatorcontrib>Spross, Christian, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of shoulder and elbow surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jost, Bernhard, MD</au><au>Benninger, Emanuel, MD</au><au>Erhardt, Johannes B., MD</au><au>Külling, Fabrice A., MD</au><au>Zdravkovic, Vilijam, MD</au><au>Spross, Christian, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The extended medial elbow approach—a cadaveric study</atitle><jtitle>Journal of shoulder and elbow surgery</jtitle><addtitle>J Shoulder Elbow Surg</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>24</volume><issue>7</issue><spage>1074</spage><epage>1080</epage><pages>1074-1080</pages><issn>1058-2746</issn><eissn>1532-6500</eissn><abstract>Background The two most commonly used approaches to expose medial elbow structures are the flexor carpi ulnaris split and the Hotchkiss over-the-top approach. The aim of this study was to define the extended medial approach to the elbow, featuring advantages of over-the-top (proximal exposure) and additional complete exposure of the coronoid and proximal medial ulna, while respecting the internervous plane between the flexor pronator mass and flexor carpi ulnaris muscle. Methods In this comparative anatomic study, 12 fresh frozen cadaveric elbows were dissected alternately to study the distal limitation and exposed area of the extended medial elbow approach compared with splitting the flexor carpi ulnaris. Results Proximal ulna exposure area was comparable between the extended medial elbow approach (average, 840 mm2 ) and the flexor carpi ulnaris split (average, 810 mm2 ; P = .44). The extended medial approach was limited distally by the posterior recurrent ulnar artery (mean 68 mm from medial epicondyle), whereas the first motor branch for the flexor carpi ulnaris muscle limited the second approach in 75% of the specimens (mean 29 mm from medial epicondyle, P < .001). Conclusions The extended medial elbow approach is a single approach allowing full exposure of the medial elbow and combining the advantages of the over-the-top approach with a safe distal extension to the medial ulna. In contrast to the flexor carpi ulnaris split, our approach respects the internervous plane.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25940381</pmid><doi>10.1016/j.jse.2015.03.013</doi><tpages>7</tpages></addata></record> |
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| subjects | Arm Bones - anatomy & histology Arm Bones - surgery Cadaver coronoid fractures Elbow Elbow - anatomy & histology Elbow - surgery Elbow Joint - anatomy & histology Elbow Joint - surgery Female flexor carpi ulnaris split Hotchkiss over-the-top Humans Male Muscle, Skeletal - surgery Orthopedics sublime tubercle surgical exposure |
| title | The extended medial elbow approach—a cadaveric study |
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