Incise the supinator muscle along its most medial edge, and gently elevate it from the bone surface only to the extent that is necessary for the required exposure. Guitton TG, Doornberg JN, Raaymakers EL, Ring D, Kloen P. J Bone Joint Surg Am. 2015 Nov;31(4):615-30. doi: 10.1016/j.hcl.2015.07.001. Indications 1. Spastic elbow contracture (This can also be performed through a posterior global approach). Clipboard, Search History, and several other advanced features are temporarily unavailable. No commercial entity has paid or will pay any foundations, educational institutions or other non-profit organisations with which the authors have affiliations. This site needs JavaScript to work properly. The lateral edge of the biceps tendon and its bursa are a useful anatomical guide to finding the medial edge of the supinator at the most proximal end of the dissection. The landmarks for the skin incision are: Proximal Jean Jose. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: Two different quality of life questionnaires were carried out: the EuroQol Five Dimensions Questionnaire (EQ-5D) and the patient-answered questionnnaire of the Liverpool Elbow Score patient (PAQ-LES). Pronate the forearm to expose the aspect of the radius lateral to the edge of the flexor carpi radialis and the radial artery. Laterally retract the superficial radial nerve, which runs under the brachioradialis on the lateral aspect of the radial artery. The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up. Dubberley JH, Faber KJ, Macdermid JC, Patterson SD, King GJ.  |  Pronate the forearm fully to expose the lateral border of the pronator teres and its insertion. Anterior approach to the elbow; Capitellum fracture; Kocher approach; Open reduction and internal fixation; Radial nerve; Trochlear fractures. Anterior approach to the elbow. The radial artery lies deep to the brachioradialis in the middle part of the forearm and between the tendons of brachioradialis and flexor carpi radialis distally. The anterior (Henry) approach offers good exposure of the whole length of the radius. Join from wherever you are in the world. Advantage 1. The length of the incision depends on the extent of exposure needed. These are predominantly the recurrent branches and those to the mobile wad. 2. Close skin and subcutaneous tissue with fine resorbable sutures (this avoids distress to the child when removing nonabsorbable sutures). Patient outcomes were assessed with physical and radiological evaluation, range-of-motion measurements with a follow-up from 24 to 60 months. extends to the anterior approach to the radius between the planes of the brachioradialis and pronator teres muscles proximally, and the brachioradialis and flexor carpi radialis (median nerve) muscles distally. 2009 Feb;91(2):390-7. doi: 10.2106/JBJS.G.01660. Isolated anterior capsular contractures. The anterior elbow approach has the benefits of simplicity, safety, minimal invasion, excellent exposure, and satisfactory prognosis. Hand Clin. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. Outcome after open reduction and internal fixation of capitellar and trochlear fractures. May 14, 2014 0 Comments . Fractures of the capitellum and trochlea. Get the latest research from NIH: It should be preferred in the treatment of ulnar coronoid process fractures and should be promoted. The anterior approach to the cubital fossa is designed primarily for exploration of the critical neurovascular structures that pass in front of the elbow joint. We describe the surgical technique and the functional outcome of eight patients with a mean of 66 years of age (range, 53-76) who where treated with open reduction and internal fixation for capitellar and trochlear fractures through the ALAE. The supinator muscle covers the lateral aspect of the proximal radius. If it is necessary to cross the elbow crease, then a Z-incision is recommended. Ballesteros-Betancourt JR, Fernández-Valencia JA, García-Tarriño R, Domingo-Trepat A, Sastre-Solsona S, Combalia-Aleu A, Llusá-Pérez M. Rev Esp Cir Ortop Traumatol. If the patho-anatomy dictates, it could be used to expose and … LEVEL OF EVIDENCEIS: Therapeutic Level III. Whenever possible, preserve at least some of its insertion. Get the latest public health information from CDC: The anterior limited approach to the elbow (ALAE) could be a valid option when treating these types of fracture, as it does not involve the detachment of any muscle group or ligament, thereby facilitating the recovery process. The posterolateral approach to the radial head is designed exclusively for surgery on that structure. Develop the interval between the brachioradialis (mobile wad) and flexor carpi radialis. Related Content AUTOPLAY ON. The anterior approach to the elbow provides excellent exposure of the anterior capsule, the anterior aspect of the proximal radioulnar joint and the anterior aspect of the collateral ligament complexes.  |  We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. Four fractures involved the capitellum, one involved the capitellum with the lateral ridge of the trochlea, and three involved the capitellum and trochlea as separate fragments. This illustration shows the extent of the incisions for the anterior approaches to the radial shaft: Note: The posterolateral (Thompson) approach also offers good access to either the middle or distal third of the radial shaft. Epub 2017 Apr 2. Four patients presented a fracture of the head of the radius (Mason type 2) and 3 fractures of the coronoid (Bryan-Morrey Type 1) associated. Andrew Howard, Theddy Slongo, Peter Schmittenbecher. The superficial muscular dissection is similar for all three parts of the Henry approach, illustrated here for the proximal third. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. The authors have also signed no agreement to receive benefits or fees from any commercial entity. 2006 Jan;88(1):46-54. doi: 10.2106/JBJS.D.02954. Least commonly used surgical approach to the elbow; provides access to the neurovascular structures. HHS By Ed Bateman 19 Videos. Reinsertion of the biceps tendon. 4. The impact of associated injuries and fracture classifications on the treatment of capitellum and trochlea fractures: A systematic review and meta-analysis. COVID-19 is an emerging, rapidly evolving situation. - anterior approach of Henry utilizes interval between brachioradialis (radial nerve) & pronator teres (or FCR distally, which are innervated by the median nerve); - this approach is often used for fractures of the radial shaft, (more often used for fractures in the distal half rather than proximal half); - disadvantages: J Bone Joint Surg Am. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. P. Escámez Fernández, G. Virador, R. Rodriguez, J. Payo Ollero 14:25. Login to view comments. Published by Elsevier Ltd. Carroll MJ, Athwal GS, King GJ, Faber KJ. Supinate the forearm and complete the exposure of the bone by any necessary elevation of the flexor pollicis longus and, more distally, pronator quadratus.