A sound knowledge of the surgical anatomy and approaches to the elbow is critical for the safe and competent execution of elbow surgery. B&M: 27 mo (13–69) 123: 180: No AVN: Type 1–6: Type 3–2: Type 4–8: Dubberley et al. The PIN runs between the 2 heads of the supinator in close proximity to the radial neck. Join from wherever you are in the world. Ó 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Introduction. Starting from the anterior aspect of the lateral humeral epicondyle the dissection follows distally the interval between the extensor muscle of the fingers and the long extensor muscle of the wrist. 4 Since the AO was founded, more than 660,000 surgeons and operating room personnel have participated in AO courses to date in over 124 countries. 2. Note Be careful of the radial nerve, which runs close to the radial head and neck. Before training, eponyms were described correctly in 38% of questions versus 47% after training. 3 Kaplan described an approach in the interval between the extensor digitorum communis and the extensor carpi radialis brevis and longus. Incise the anterolateral joint capsule longitudinally. December 3-6, 2020, Hip periprosthetic fracture module is now online. 215,000 Global community. Background: The aim of this study was to compare the complete visible surface area of the radial head, neck, and coronoid in the Kaplan and Kocher approaches to the lateral elbow. Landmarks . These descriptions denote the deep surgical interval employed (Table 1). Anterior facet of the distal humerus. Just as we are sure others do, we prefer certain surgical approaches to others to treat specific elbow injuries or disorders (Table 1.3). A generalized … Skin incision. Anterior facet of the coronoid process. The lateral Kocher/Kaplan approach can be used to access the radial head and the tip of the coronoid. This video is a cadaveric dissection for exposure to the radial head through the lateral side. This way the anterolateral aspect of the radiohumeral joint capsule is exposed. Landmarks and incision. Elbow Kaplan Approach. Kocher approach between anconeus and extensor carpi ulnaris (ECU) is the most commonly used approach for radial head surgery. Case series, 28 patients, 43 y.o. Position of patient. To perform the Kaplan (lateral) approach to the proximal radius, a skin incision is made on the lateral aspect of the elbow from the epicondyle extending distally 4 cm toward the ulnar styloid process. The brachioradialis: A fleshy muscle that forms the lateral border of the supinated forearm. 1. We hope that this review of the pertinent surgical anatomy and approaches furthers the practice of the art of elbow surgery. Copyright © 2020 Lineage Medical, Inc. All rights reserved. Tendon of the biceps: Band-like structure that runs … Kocher approach and Kaplan approach. Introduction. The patient is placed supine on the operating table. It passes distally to the lateral surface of the proximal forearm, posterior to the radial head. Least commonly used surgical approach to the elbow; provides access to the neurovascular structures. training at an AO Advanced Elbow Trauma Course, we aimed to report on (1) the accuracy and (2) reliability of 10 common eponymous terms used for surgical approaches and fractures in elbow surgery. The interval between the extensor digitorum communis and the extensor carpi radialis brevis and longus is developed, exposing the underlying capsule, which is incised longitudinally to gain … It divides into its superficial and deep branches at the level of the radial head. A major disadvantage of Kocher approach is inability to expose the posterior interosseous nerve (PIN). Dubberley: 56 mo (14–121) 119: 156: 3 AVN: ORIF using Boyd, Kaplan, … Kocher’s approach utilizes the interval between the anconeus and the extensor carpi ulnaris and can be extended proximally and distally. intermuscular: triceps (radial n.) and brachioradialis/ECRL (radial n.) pronation of forearm moves PIN ~1cm further from the radiocapitellar joint; supination moves PIN ~1cm closer to radiocapitellar joint. Surgical Approaches to the Elbow Luke S. Austin Joseph A. Abboud Matthew L. Ramsey Gerald R. Williams Jr. ELBOW APPROACHES The surgical exposures described for the elbow are divided into posterior, medial, and lateral approaches. Skin incision. The percentage of correct answers only improved significantly in one question (P<0.005). The AO clinical divisions and clinical unit continually redefine the state-of-the-art in their fields, maintaining activities in research, development, clinical investigation and education. The word eponym is derived from the Ancient Greek language and means ‘‘named after.’’ In general, a surgical procedure, disease, or fracture pattern that is named after the person who … allows exposure of the radial head, coronoid and anterolateral distal humerus, should only be done by experienced surgeons familiar with anatomy in this region given significant risk of injury to PIN, cadaveric study: 50% PIN, 35% superficial sensory, 15% radial nerve proper, risks: pneumothorax, phrenic nerve paresis, "sloppy lateral" - bump under ipsilateral scapula, arm draped over chest, sterile best if proximal extension anticipated, make 4cm longitudinal incision from tip of lateral epicondyle distally towards Lister's tubercle, dentify ECRB / EDC interval and bluntly develop plane, etract ECRB radial and EDC ulnar to expose, detach humeral and ulnar heads of the supinator, to visualize annular ligament and capsule deep, istal: posterolateral approach to the forearm (, extend skin incision distally, still aiming towards Lister's tubercle, develop ECRB / EDC interval to visualize distal extent of supinator, can palpate as bulge in muscle belly or make small nick in the muscle and dissect to find the nerve, travels within subcutaneous fat at the distal aspect of the incision, more anterior approach avoids injury to LCL complex, but if LCL is traumatically disrupted it is difficult to access and repair via the Kaplan approach, necessitates release of EDC to visualize LCL complex, Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Direct Lateral Approach (Hardinge, Transgluteal), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine, same as proximal extension of Kocher approach, intermuscular: triceps (radial n.) and brachioradialis/ECRL (radial n.), supinate arm to bring supinator insertion into surgical field, incise supinator along radial insertion and elevate subperiosteally to expose the radial shaft, more anterior, greater risk than Kocher approach, pronation of forearm moves PIN ~1cm further from the radiocapitellar joint; supination moves PIN ~1cm closer to radiocapitellar joint. Please rate topic. The Kaplan approach is a frequently used lateral approach which provides excellent exposure of the: Proximal radius. Kocher approach and Kaplan approach. For a lateral skin incision, place the elbow at 90 degrees and try to pinch the lateral condyle (easier in thin patients). Keywords: Eponyms; history; orthopaedics; elbow; fracture Eponyms are commonly used in orthopaedic and trauma surgery. 58,000 … The anterior limited approach of the elbow for the treatment of capitellum and ... using Kaplan approach: 1A–11: 2A–7: Ruchelsman et al., Case series,16 patients, ORIF using extensile lateral approach: 40 y.o. The interval between the extensor muscle of the fingers and the long extensor muscle of the wrist is identified. 2. Either a posterior skin incision with a lateral skin flap or a lateral skin incision can be used. The Kaplan approach is a frequently used lateral approach which provides excellent exposure of the: The incision starts over the lateral supracondylar ridge, 5 cm proximal to the elbow joint. Often, these deep approaches can be performed through a direct… Mariusz Bonczar, Daniel Rikli, David Ring. Note Be careful when placing the anterior retractor as the radial nerve is at risk. Apply a tourniquet after exsanguinating the limb. 830 Educational events per year. The incision starts over the lateral supracondylar ridge, 5 … Subperiosteal reflection of the brachioradialis and extensor carpi radialis longus anteriorly, and the triceps posteriorly will improve joint exposure. The deep fascia is incised in line with the skin incision. Level of evidence: Narrative Review.

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