Master Tech Ortho Surgery Elbow CH1


PART I Exposures

Technique ●● The flaps are elevated medially and laterally exposing the fascia of the triceps (Fig. 1A-15). ●● The fascia comprising the distal two-thirds of the triceps mechanism is split in line with its fibers in the midline from proximal to distal. The triceps is elevated medially and laterally to expose the humeral shaft (Fig. 1A-16).



Comment The limiting factor of this procedure is the presence of the radial nerve as it enters the intermuscular septum proximally and laterally just distal to the deltoid attachment.

CHAPTER 1B: THE ELBOW There are two conceptual incision types for the elbow: an extensile posterior or for purpose incisions. For extensile exposures, a straight posterior or posterior lateral incision is used (Fig. 1B-1). For fear of injuring the ulnar nerve, a posterior incision of variable length (12 to 18 cm) is placed just medial or lateral to the tip of the olecranon and not directly over the cubital tunnel (Fig. 1B-2). We term the posterior exposure the “universal” incision (Fig. 1B-3) since both medial and lateral elbow pathol- ogy can be addressed through a posterior skin incision by elevating skin flaps (Fig. 1B-4). However, care must be taken to keep the flap as thick as possible and elevate only to the extent needed.

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