Elbow dislocation approach for complex elbow fractures: a cadaveric study

• Published in: Journal of orthopaedic surgery and research Vol. 18; no. 1; p. 978
• Main Authors: Liu, Yang, Gao, Yuling, Xu, Xiaopei, Zhao, Yanrui, Wang, Hanzhou, Sun, Qingnan, Zhao, Binzhi, Wang, Siyuan, Zhou, Junlin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.12.2023; BioMed Central; BMC
• Subjects: Analysis; Anatomy; Autopsies; Cadaver; Cadavers; Complex elbow fracture; Coronoid process of ulna; Dislocation; Distal humerus; Elbow; Elbow - surgery; Elbow dislocation; Elbow Fractures; Elbow Joint - surgery; Fracture Fixation, Internal; Humans; Humeral Fractures - surgery; Humerus; Humerus - surgery; Injuries; Joint Dislocations - surgery; Ligaments; Methods; Methylene blue; Olecranon osteotomy approach; Orthopedic surgery; Orthopedics; Osteotomy; Software; Surgeons; Surgical approach; Surgical techniques; Ulna; Distal humerus; Cadaveric study; Surgical approach; Olecranon osteotomy approach; Complex elbow fracture; Coronoid process of ulna; Elbow dislocation; Articular exposure
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-023-04478-x

Approach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process. A total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach. The total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P < 0.001), the capitulum 100% and 32.4 (28.0, 39.2)% (P < 0.001), the trochlea 93.2(90.1, 96.9)% and 72.5 (65.2, 78.8)% (P < 0.001), the anterior trochlear articular surface 96.0(93.0, 97.4)% and 50.3 (43.6, 59.1)% (P < 0.001), the posterior trochlear articular surface 95.4 (93, 100)% and 100% (P = 0.76) and the articular surface of the coronoid process of ulna 71.3 (66.0, 74.2)% and 0% (P < 0.001). For complex elbow fractures, the technique of elbow dislocation provides complete exposure of the distal humerus surface and a significant portion of the coronoid process surface, facilitating direct visualization for reduction and fixation. Level of evidence Anatomy Study; Cadaver Dissection.