Abstract
Introduction
In elbow surgery; posterior side of joint has been described as the front door for accessing the elbow pathologies. Triceps splitting, triceps reflection, posterolateral Kocher, posteromedial Bryan-Morrey, modified MacAusland transolecranon approaches are the well known posterior surgical approaches. In the English literature, release and transposition of ulnar nerve on the medial side was fully described in posterior approaches. We believe that there was a need to identify the structures at the lateral aspect of the elbow while an iatrogenic injury may inversely effect an excellent radiological result. Therefore, we exposed the detailed innervation supply to the anconeus muscle and medial head of triceps muscle and tried to show possible denervation sites of these two structures during posterior approaches.
Materials and methods
This study was performed on 14 elbows in formalin-preserved 7 cadavers. We exposed the course of the innervation supply to the medial head of triceps muscle and anconeus muscle and tried to show possible denervation sites of these two structures during posterior approaches. The branching pattern of radial nerve innervating anconeus muscle and its deriving level from radial nerve was identified. Distance from a vertical line which is passing through lateral epicondyle to branching point was measured.
Results
The mean distance of the branching point of the nerve to medial head of triceps muscle and anconeus was 168.3 mm (range 130.36–185.4). The nerve to anconeus muscle ran along the posterior aspect of the humerus from the horizontal line passing through lateral epicondyle at a distance of 142.20 mm (range 153.72–136.41) medial to olecranon and at a distance of 47.45 mm (range 77.13–30.14) lateral to olecranon.
Conclusion
Although splitting the fibers of triceps proximaly increases the exposure of the posterior humerus, innervation of the lateral portion of the medial head of triceps muscle and anconeus muscle may be jeoparadized. Therefore, surgeons who have interest in elbow surgery; (1) should revise the course of the nerve to medial head of triceps and anconeus muscle, (2) be aware of possible iatrogenic injury of the extensor muscles of the elbow via transtricipital approaches, (3) try to choose a more conservative posterior surgical approach.
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References
Henley MB (1987) Intra-articular distal humeral fractures in adults. Orthop Clin North Am 18(1):11–23
O’Driscoll SW (2000) The triceps reflecting anconeus (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am 31:91–101
Patterson SD, Bain GI, Mehta JA (2000) Surgical approaches to the elbow. Clin Orthop 370:19–33
Gschwend N, Loehr G, Ivosevic-Radonovic D et al. (1988) Semiconstrained elbow prosthesis with special reference to the GSB III prosthesis. Clin Orthop 232:104–111
Kocher T (1911) Operations at the elbow. Textbook of operative surgery, 3rd edn. Adam & Charles Black, London, pp 313–318
Bryan RS, Morrey BF (1982) Extensive posterior exposure of the elbow. A triceps-sparing approach. Clin Orthop 166:188–192
MacAusland WR (1915) Anklylosis of the elbow: with report of four cases treated by arthroplasty. JAMA 64:312–318
Gupta R, Khanchandani P (2002) Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury 33:511–515
Ring D, Jupiter JB, Gulotta L (2003) Articular fractures of the distal part of the humerus. J Bone Joint Surg 85(A):232–237
Hastings H, Cohen M (2002) General deep approaches: lateral approaches. Tech Shoulder Elbow Surg 3:10–15
Wilkinson JM, Stanley D (2001) Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elbow Surg 10:380–382
Gerwin M, Hotchkiss RN, Weiland A (1996) Alternative operative exposures of the posterior aspect of the humerus diaphysis. J Bone Joint Surg 78(A):1690–1695
Frankle MA (2002) Triceps split technique for total elbow arthroplasty. Tech Shoulder Elbow Surg 3(1):23–27
Gofton WT, MacDermid JC, Patterson SD, Faber KJ, King GJ (2003) Functional outcome of AO type C distal humeral fractures. J Hand Surg 28(A):294–302
Helfet DL, Kloen P, Anand N, Rosen HS (2003) Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Joint Surg 85(A):33–40
McKee MD, Kim J, Kebaish K, Stephen DJG, Kreder HJ, Schemitsch EM (2000a) Functional outcome after open supracondylar fractures of humerus. The effect of the surgical approach. J Bone Joint Surg 82(B):646–651
McKee MD, Wilson T, Winston L, Schemitsch EH, Richards RR (2000b) Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg 82(A):1701–1707
O’Driscoll SW, Sotelo JS, Torchia ME (2002) Management of the smashed distal humerus. Orthop Clin North Am 33:19–33
Wang AA, Mara M, Hutchinson DT (2003) The proximal ulna: an anatomic study with relevance to olecranon osteotomy and fracture fixation. J Shoulder Elbow Surg 12:293–296
Sunderland S (1978) Nerves and nerve injuries. 2nd edn. Churchill Livingstone, New York pp 802–819
Gleason TF, Goldstein WM, Ray RD (1984) The function of the anconeus muscle. Clin Orthop 192:147–148
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Özer, H., Açar, H.İ., Cömert, A. et al. Course of the innervation supply of medial head of triceps muscle and anconeus muscle at the posterior aspect of humerus (anatomical study). Arch Orthop Trauma Surg 126, 549–553 (2006). https://doi.org/10.1007/s00402-006-0183-9
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DOI: https://doi.org/10.1007/s00402-006-0183-9