A posterior approach to the elbow joint

Shahane, Shantanu; Stanley, David

doi:10.1302/0301-620x.81b6.0811020

Cited by 38 publications

(18 citation statements)

References 5 publications

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“…At the second-stage procedure the previous incision was used and a posterior approach made to the elbow. 7 The ulnar and radial nerves were identified and protected. The antibiotic-impregnated cement rods and beads were removed and the joint cavity further debrided.…”

Section: Methodsmentioning

confidence: 99%

“…At the end of the procedure the extensor mechanism was repaired to the olecranon/allograft using non-absorbable stitches. 7 Reconstructions were performed using one Stanmore (Biomet UK Ltd, Swindon, United Kingdom), one Souter-Strathclyde (Stryker Howmedica Osteonic, Limerick, Ireland) and nine Coonrad-Morrey (Zimmer, Warsaw, Indiana) replacements.…”

Section: Methodsmentioning

confidence: 99%

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Allograft-prosthesis composite reconstruction for the management of failed elbow replacement with massive structural bone loss

Amirfeyz

Stanley

2011

The Journal of Bone and Joint Surgery. British volume

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We studied, ten patients (11 elbows) who had undergone 14 allograft-prosthesis composite reconstructions following failure of a previous total elbow replacement with massive structural bone loss. There were nine women and one man with a mean age of 64 years (40 to 84), who were reviewed at a mean of 75 months (24 to 213). One patient developed a deep infection after 26 months and had the allograft-prosthesis composite removed, and two patients had mild pain. The median flexion-extension arc was 100° (95% confidence interval (CI) 76° to 124°). With the exception of the patient who had the infected failure, all the patients could use their elbows comfortably without splints or braces for activities of daily living. The mean Mayo Elbow Performance Index improved from 9.5 (95% CI 4.4 to 14.7) pre-operatively to 74 (95% CI 62.4 to 84.9) at final review. Radiologically, the rate of partial resorption was similar in the humeral and ulnar allografts (three of six and four of eight, respectively; p > 0.999). The patterns of resorption, however, were different. Union at the host-bone-allograft junction was also different between the humeral and ulnar allografts (one of six and seven of eight showing union, respectively; p = 0.03). At medium-term follow-up, allograft-prosthesis composite reconstruction appears to be a useful salvage technique for failed elbow replacements with massive bone loss. The effects of allograft resorption and host-bone-allograft junctional union on the longevity of allograft-prosthesis composite reconstruction, however, remain unknown, and it is our view that these patients should remain under long-term regular review.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Allograft-prosthesis composite reconstruction for the management of failed elbow replacement with massive structural bone loss

Amirfeyz

Stanley

2011

The Journal of Bone and Joint Surgery. British volume

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“…This did not describe mobilising the triceps medially, nor describe the approach to the distal humerus as has been suggested by some authors. 1,6,7 To the best of our knowledge, this is the first description of the posteriolateral approach to the distal humerus using this approach. We feel it will be of use to surgeons treating fractures of the distal humerus.…”

Section: Discussionmentioning

confidence: 94%

“…Other authors have modified this approach where the triceps is split leaving 25% medially with the ulna nerve and mobilising the remaining 75% laterally. 7 This approach appears to reduce the risk of ulna nerve injury with one temporary ulna nerve neuropraxia in a series of 106 patients. This approach still has the disadvantages of dividing and disrupting the extensor mechanism.…”

Section: Discussionmentioning

confidence: 99%

The triceps–flexor carpi ulnaris (TRIFCU) approach to the elbow

Deakin

Deshmukh

2010

annals

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Ann R Coll Surg Engl 2010; 92: 240-242 240Intra-articular fractures of the distal humerus frequently require internal fixation. Several approaches have been described, with the posterior approaches being most common. These include the olecranon osteotomy approach, tongue of triceps approach, posteriomedial approach, posteriolateral approach and tricep splitting approaches. [1][2][3][4] We present a new approach to the distal humerus via the lateral border of the triceps muscle. Patients and Methods Operative techniqueThe anaesthetized patient is positioned in a lateral position with the upper arm resting on a support and the elbow flexed. A tourniquet is placed as proximally as possible on the arm. With the arm hanging over the support, we prefer that the hand is rested on a Mayo table to keep the elbow flexed to approximately 20º. A standard midline posterior incision is made over the elbow from approximately 15 cm above the olecranon to 10 cm bellow the olecranon. The incision is curved laterally around the olecranon to avoid the scar lying directly over the olecranon. The skin and subcutaneous tissues are reflected laterally and medially exposing the triceps and olecranon (Fig. 1). Next, the ulna nerve is identified proximally and followed distally around the medial epicondyle. Care is taken not to mobilise or directly handle the nerve to minimise the risk of neuropraxia. We do not routinely use a tape around the ulna nerve to identify or retract it. The lateral border of the triceps muscle is identified and a plane is developed between this muscle and the lateral intermuscular septum. The lateral border of the insertion of triceps on the tip of the olecranon is identified. The anconeus muscle lies lateral to this plane. The triceps is reflected medially and, as this progresses distally, fascia covering the anconeus muscle is encountered. This fascia is incised half-way over the anconeus muscle. The distal insertion of anconeus muscle is detached and reflected medially away from its insertion, exposing the lateral border of the ulna (Fig. 2). As the triceps is being medially reflected, the origins of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) are encountered. These are subperiosteally reflected medially with the triceps tendon Intra-articular fractures of the distal humerus frequently require internal fixation. Several approaches have been described, with the posterior approaches being most common. We present a new approach to the distal humerus via the lateral border of the triceps muscle. PATIENTS AND METHODS The senior author has used this technique for fixation of intra-articular fractures of the distal humerus in 12 patients. RESULTS The approach is equally useful for intra-and extra-articular fractures. No cases of postoperative ulna nerve neuropraxia have been encountered. There have been no postoperative wound complications. The exposure has allowed sufficient access to allow anatomically contoured plates to be easily applied to both sides of the distal humerus with confi...

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“…Shahane and Stanley [20] reported on a modification of this approach in an attempt to reduce the incidence of ulnar neuropathy. After decompression of the ulnar nerve the triceps is split leaving a quarter of triceps medially and the rest is reflected medially as a single unit.…”

Section: Modificationsmentioning

confidence: 99%