Master Tech Ortho Surgery Elbow CH1

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1  Exposures of the Upper Extremity: Humerus, Elbow, Forearm

Note : Care is taken to tie this stitch off to the side of the subcutaneous border of the ulna to avoid irritation or skin erosion. ●● To snugly stabilize the triceps insertion against the olecranon, a second suture is placed trans- versely across the ulna, again, beginning on the side from which the triceps reflection began (Fig. 1B-52). It is brought back across the triceps tendon in a transverse fashion with a locked stitch in the mid/lateral portion of the tendon (Fig. 1B-53). The suture then passes through the lateral margin of the triceps.

FIGURE 1B-53

FIGURE 1B-52

●● All sutures are tied with the elbow in 90 degrees of flexion, again with the knots off the subcuta- neous border. Medial exposure of the coronoid Note: This may be a limited exposure but is capable of considerable extension as needed.

Indications  Coronoid fracture. Landmarks  Medial epicondyle, olecranon. Position  Elbow table.

There are two relevant exposures to the medial aspect of the elbow. The first is a focused expo- sure to allow identity and management of coronoid fractures. The second is a more extensile medial approach that affords an opportunity to release the anterior and posterior elbow capsules as well as manage fractures and a broader spectrum of pathology. Focused Medial Exposure of the Coronoid Note: While this is a limited exposure, it can be modified to a more extensile exposure as described below.

Indications  Coronoid fracture, specifically application of a buttress plate. Landmark  Medial epicondyle, ulnar nerve, flexor carpi ulnaris.