Master Tech Ortho Surgery Elbow CH1
PART I Exposures
Technique ●● The interval between the biceps and brachialis is developed by blunt and sharp dissection. ●● The terminal branch of the musculocutaneous nerve is identified and protected as the skin incision extends distally (Fig. 1C-11). ●● The origin of the biceps on the radial tuberosity is identified medially. Laterally, the brachioradia- lis muscle is observed along with the radial nerve (Fig. 1C-13) that travels in the interval between the brachioradialis and brachialis muscles proximally. Note : Observe proximity of the posterior interosseous nerve to the anterior capsule over the radial head. ●● The forearm fascia is split distally between the pronator teres medially and the brachioradialis muscle laterally (Fig. 1C-14). The pronator teres muscle belly is followed distally and is retracted exposing the supinator muscle and the pronator attachment. ●● By supinating the forearm, the radial origin of the supinator muscle is identified. The posterior interosseous nerve is observed entering under the arcade of Froche (Fig. 1C-15). The superficial radial nerve is identified on the undersurface of the brachioradialis and protected. ●● The supinator muscle is released from the proximal radius, exposing the anterior aspect of the proximal radius (Fig. 1C-16A and B). ●● The fascia between the brachioradialis and the pronator teres and flexor carpi radialis is split distally (Fig. 1C-17). ●● The brachioradialis along with the radial nerve is retracted laterally, and the pronator teres and flexor carpi radialis muscles are retracted medially. The insertion of the pronator teres is identified at the proximal aspect of the dissection (Fig. 1C-18). ●● Pronation of the forearm allows visualization of the attachment of the pronator teres and flexor pollicis longus. Distally the pronator quadratus is elevated from the medial aspect of the radius (Fig. 1C-19). ●● By supinating the forearm, sharp periosteal elevation of all remaining muscular attachments of the radial shaft allows complete exposure of the radius (Fig. 1C-20). ●● The recurrent branch of the radial artery is identified and ligated (Fig. 1C-12). ●● Pearl: This is the key step that allows distal expansion of this exposure.
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