Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
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A modified trans-anconeus approach to facilitate fixation of a posterior radial head fracture: a cadaveric feasibility study

  • Ahmed Mohamed Desouky (Department of Anatomy, Faculty of Medicine, Ain Shams University) ;
  • Ahmed Naeem Atiyya (Department of Orthopaedic, Faculty of Medicine, Ain Shams University) ;
  • Mohamed Elbishbishi (Department of Orthopaedic, Faculty of Medicine, Ain Shams University) ;
  • Marwa Mohamed El Sawy (Department of Anatomy, Faculty of Medicine, Ain Shams University)
  • Received : 2022.10.10
  • Accepted : 2022.12.14
  • Published : 2023.03.31
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Abstract

Fixation of radial head fracture with minimally invasive posterior approach remains a significant challenge. The aim of this study was to determine the feasibility of trans-anconeus posterior elbow approach and to observe lateral ulnar collateral ligament (LUCL) in extended elbows. This cadaveric study was performed in twenty upper limbs of fresh fixed adult male cadavers. An oblique incision was made in the middle segment of anconeus until the lateral ligament complex and the joint capsule had been revealed. A deep dissection was explored to observe the anatomical relationship of the LUCL to the anconeus. Measurements of the LUCL were recorded while the elbow was fully extended. The mean distance between the edge of the radial head and the proximal insertion of the LUCL was 13.3 mm (11.5-16.2 mm); the mean distance between the edge of the radial head and the distal insertion of the LUCL was 20.9 mm (19.2-23.4 mm); the distance between the edge of the radial head and the distal edge of the annular ligament was 11.2 mm (8.22-11.7 mm). By estimate correlation of the previous measurements, the direct and accessible way to expose the posterolateral articular capsule of the elbow joint was through a window in medial 2/3 of the middle segment of anconeus muscle. These trans-anconeus approach is useful. It provides good visualization, facilitates applying the implants, and lessens the risk of radial nerve injury. Awareness of the anatomy is mandatory to avoid injury of LUCL.

Keywords

Acknowledgement

The authors would like to extend their appreciation to Technical Staff of the Center of Donors of Cadavers and dissecting Rooms of anatomy department, Faculty of medicine, Ain Shams University for supporting this research. Also, we would like to thank the participants, the study investigators and the staff at the clinical centers for generating the image data sets used in this research.

References

  1. Duckworth AD, McQueen MM, Ring D. Fractures of the radial head. Bone Joint J 2013;95-B:151-9.
  2. Gawande J, Jain S, Santoshi JA. Neglected bilateral radial head fracture with a rare presentation: a case report. Chin J Traumatol 2017;20:246-8.
  3. Capo JT, Shamian B, Francisco R, Tan V, Preston JS, Uko L, Yoon RS, Liporace FA. Fracture pattern characteristics and associated injuries of high-energy, large fragment, partial articular radial head fractures: a preliminary imaging analysis. J Orthop Traumatol 2015;16:125-31.
  4. Moritomo H, Murase T, Arimitsu S, Oka K, Yoshikawa H, Sugamoto K. The in vivo isometric point of the lateral ligament of the elbow. J Bone Joint Surg Am 2007;89:2011-7.
  5. Stipp WN, Ribeiro FR, Tenor Junior AC, Filardi Filho CS, Molin DCD, Petros RSB, Brasil Filho R. Anatomical parameters in the lateral ulnar collateral ligament reconstruction: a cadaver study. Rev Bras Ortop 2013;48:52-6.
  6. Wegmann K, Burkhart KJ, Zimmermann J, Dargel J, Nijs S, Konerding MA, Muller LP. The interference of distal humeral plating with the medial and lateral collateral ligaments of the elbow. Arch Orthop Trauma Surg 2014;134:501-7.
  7. Hackl M, Bercher M, Wegmann K, Muller LP, Dargel J. Functional anatomy of the lateral collateral ligament of the elbow. Arch Orthop Trauma Surg 2016;136:1031-7.
  8. Coriolano M, Lins OG, Amorim MJ, Amorim AA. Anatomy and functional architecture of the anconeus muscle. Int J Morphol 2009;27:1009-12.
  9. Mellema JJ, Eygendaal D, van Dijk CN, Ring D, Doornberg JN. Fracture mapping of displaced partial articular fractures of the radial head. J Shoulder Elbow Surg 2016;25:1509-16.
  10. Kim DK, Kim MJ, Kim YS, Oh CS, Lee SS, Lim SB, Ki HC, Shin DH. Long bone fractures identified in the Joseon Dynasty human skeletons of Korea. Anat Cell Biol 2013;46:203-9.
  11. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 1954;42:123-32.
  12. Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res 1987;(216):109-19.
  13. Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 1962;31:51-6.
  14. Iwasaki N, Kato H, Ishikawa J, Masuko T, Funakoshi T, Minami A. Autologous osteochondral mosaicplasty for osteochondritis dissecans of the elbow in teenage athletes: surgical technique. J Bone Joint Surg Am 2010;92(Suppl 1 Pt 2):208-16.
  15. Pereira BP. Revisiting the anatomy and biomechanics of the anconeus muscle and its role in elbow stability. Ann Anat 2013;195:365-70.
  16. Jimenez-Diaz V, Aragones P, Garcia-Lamas L, Barco-Laakso R, Quinones S, Konschake M, Gemmell C, Sanudo JR, Cecilia-Lopez D. The anconeus muscle revisited: double innervation pattern and its clinical implications. Surg Radiol Anat 2021;43:1595-601.
  17. Chaware PN, Santoshi JA, Patel M, Ahmad M, Rathinam BAD. Surgical implications of innervation pattern of the triceps muscle: a cadaveric study. J Hand Microsurg 2018;10:139-42.
  18. Van Den Broek M, Van Riet R. Intra-articular capacity of the elbow joint. Clin Anat 2017;30:795-8.
  19. Bartonicek J, Nanka O, Tucek M. [Kocher approach to the elbow and its options]. Rozhl Chir 2015;94:405-14. Czech.