Master Tech Ortho Surgery Elbow CH1
PART I Exposures
MAYO OLECRANON OSTEOTOMY OF THE ELBOW: ANCONEUS PRESERVING Concern with regard to transecting the anconeus attachment to the triceps has prompted the devel- opment of an olecranon osteotomy that preserves the anconeus origin and viability. The attractive- ness of this exposure is that the anconeus dissection can be done very safely and quickly. This does preserve the anconeus triceps continuity in the event that a later reconstructive procedure may be necessary that uses the anconeus.
Position The patient is supine with the arm across the chest.
Technique ●● Deep exposure is at the Kocher interval between the extensor carpi ulnaris and anconeus. The interval is entered, and the anconeus is identified and isolated (Fig. 1B-9). ●● The anconeus is elevated from its bed by sharp dissection leaving the attachment of its origin at the fascial expansion of the triceps, and the midportion of the sigmoid notch is identified laterally (Fig. 1B-10A and B). ●● Medially, the ulnar nerve is identified (Fig. 1B-11A and B), and the midportion of the medial ulnohumeral articulation is exposed (Fig. 1B-12A and B). ●● A V-shaped osteotomy is carried out as above with an oscillating saw (Fig. 1B-13). The oste- otomy is completed with an osteotome (Fig. 1B-14) ●● The osteotomized olecranon along with the attached anconeus is elevated proximally (Fig. 1B-15). ●● Closure consists of the standard AO reattachment of the olecranon. The anconeus is brought back to its insertion on the ulna. The fascia over the anconeus is closed with a running 2-0 absorbable suture (Fig. 1B-16). TIP : The ulnar nerve does not need to be mobilized unless dictated by the pathology.
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