A posterior approach to the elbow joint based on the blood supply to the triceps muscle
- 185 Downloads
We describe a posterior approach to the elbow joint based on anatomical studies of the blood supply to the triceps muscle, and observation of the musculotendinous insertion of triceps. These studies demonstrated that the triceps muscle is essentially supplied by end arteries. Any distal-proximal anastamoses from the collateral branches of the radial and ulnar arteries, occur at the small vessel level. The insertion of triceps is musculotendinous with an aponeurosis consisting of two laminae, one superficial and one deep, as well as direct muscle insertion into the olecranon. Our approach provides an excellent exposure of the distal humerus without the division of any fibers of triceps preventing any muscle necrosis and scarring. We formally dissect the two laminae of the triceps aponeurosis, and divide the deeper intramuscular aponeurosis 2 cm proximal to the olecranon. At closure, correct tensioning of the intramuscular aponeurosis allows for soft tissue balancing and optimum elbow function. We use this approach for total elbow replacement, open reduction and internal fixation of distal humerus fractures and in the open reduction of displaced supracondylar fractures in children. We have had no cases of a triceps tendon dehiscence in over 400 cases.
KeywordsTriceps preserving Vascular studies Anatomical safe Reproducible
No funds were received in support of this study.
Conflict of interest statement
No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
- 1.MacAusland WR (1915) Ankylosis of the elbow, with report of four cases treated by arthroplasty. J Am Med Assoc 64:312–318Google Scholar
- 2.Morrey BF, Bryan RS, Dobbyns JH, Linscheid RL (1981) Total elbow arthroplasty: a five-year experience at the Mayo clinic. J Bone Joint Surg 63-A:1050–1063Google Scholar
- 3.Steiger JU, Gschwend N, Bell S (1985) GSB elbow arthroplasty: a new concept and six years experience. In: Kashiwagi D (ed) Elbow joint. Elsevier Science Publishers BV (Biomedical Division), Amsterdam, pp 285–294Google Scholar
- 4.Wolfe SW, Ranawat CS (1990) The osteoanconeus flap: an approach for total elbow arthroplasty. J Bone J Surg 72-A:684–688Google Scholar
- 6.Muller ME, Allgower M, Willenegger H (1970) Manual of internal fixation: technique recommended by the AO group. Springer-Verlag, New YorkGoogle Scholar
- 7.Agur AMR, Lee MJ (eds) (1999) Grant’s atlas of anatomy, 10th edn. Lippincott Williams & Wilkins, Baltimore, pp 449–464Google Scholar
- 8.Gosling JA, Harris PF, Humpherson JR, Whitmore I, Willan PLT (eds) (1996) Human anatomy, 3rd edn. Mosby-Wolfe, London, pp 3.34–3.35Google Scholar
- 9.McMinn RMH (ed) (1990) Last’s anatomy – regional and applied, 8th edn. Churchill Livingstone, Edinburgh, pp 1–707Google Scholar
- 10.Standring S (ed) (2005) Gray’s anatomy: the anatomical basis of clinical practice, 39th edn. Elsevier Churchill Livingstone, p 855Google Scholar
- 13.Romanes GJ (ed) (1981) Cunningham’s textbook of anatomy, 12th edn. Oxford University Press, Oxford, pp 323–324Google Scholar