Master Tech Ortho Surgery Elbow CH1
PART I Exposures
Medial Exposures Posterior Medial Exposure—The Mayo Approach (Bryan-Morrey) Indications Ankylosis release, total elbow arthroplasty, ORIF medial column, distal humeral fractures. Position Supine, arm across the chest. Landmarks Medial epicondyle, olecranon, subcutaneous borer of ulna. Skin Incision Seven centimeters proximal and 7 cm distal and just medial to the tip of the olecranon. Technique The ulnar nerve is released from the margin of the triceps and elevated from its bed (Fig. 1B-40). The cubital tunnel retinaculum is split, and the nerve is released to the first motor branch. A subcutaneous pocket is developed, the intermuscular septum is removed (Fig. 1B-41), and the nerve is translated anteriorly. ●● A sleeve of tissue consisting of the forearm fascia and ulnar periosteum is elevated from the medial margin of the ulna. ●● The attachment of the triceps to the olecranon is released by sharp dissection (Fig. 1B-42). ●● The distal forearm fascia and ulnar periosteum are elevated from the ulna. ●● The extensor mechanism and capsule continue to be reflected from the lateral epicondyle, and the anconeus is released from the ulna (Fig. 1B-43).
FIGURE 1B-40 Through a posterior skin incision, the ulnar nerve has been identified and dissected from its bed at the margin of the triceps. The cubital tunnel retinaculum has been released with further dissection to the first motor branch. It is translocated anterior to the medial epicondyle to a subcutaneous pocket.
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