Purpose
The current methods of distal humerus (DH) articular surface visualization only allow
a limited view of the joint. This study describes an osteotomy procedure that increases
the visualization of and access to the DH articular surface for fixation without compromising
ligaments.
Methods
Eighteen fresh-frozen human elbows (9 matched pairs) underwent proximal ulna osteotomy
(PUO) or transverse olecranon osteotomy (OO) contralaterally. The visualized articular
surface of the DH was demarcated, and the surface areas of the DH, capitellum, and
trochlea were measured using 3-dimensional scanning. The angular arc of the articular
surface of the capitellum and trochlea was measured using a goniometer.
Results
The 3-dimensional scans showed that 87.6% of the total DH surface area was visualized
using PUO versus 65.6% using OO. When the trochlea and capitellum surface areas were
separated, 94.0% versus 75.9% of the trochlea and 74.8% versus 44.7% of the capitellum
were visualized using PUO and OO, respectively. The goniometric angles demonstrated
that 98.2% versus 70.9% of the trochlea and 75.1% versus 43.5% of the capitellum articular
surface arc angles were visualized using PUO and OO, respectively. After PUO with
further release of the flexor-pronator mass was performed, 100% of the DH articular
surface was visualized.
Conclusions
Proximal ulnar osteotomy improves the visualization of the DH articular surface.
Clinical relevance
Proximal ulna osteotomy spares ligaments, avoids osteotomizing the greater sigmoid
notch, involves more robust metaphyseal bone for potentially better fixation, and
may permit DH arthroplasty without compromising primary ligamentous elbow stabilizers.
Further clinical studies are needed to assess the utility of this type of osteotomy.
Key words
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References
- Extensive posterior exposure of the elbow. A triceps-sparing approach.Clin Orthop Relat Res. 1982; 166: 188-192
- Incision for exposure of the elbow joint.Am J Surg. 1932; 15: 65-67
- Capitellar and trochlear fractures.Hand Clin. 2015; 31: 615-630
- Surgical approaches to the elbow.Hand Clin. 2004; 20: 375-387
- A posterior approach to the elbow joint.J Bone Joint Surg Br. 1999; 81: 1020-1022
- Ankylosis of the elbow: with report of four cases treated by arthroplasty.JAMA. 1915; 64: 312-318
- The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus.J Orthop Trauma. 2006; 20: 164-171
- Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus.J Orthop Trauma. 2004; 18: 446-449
- Posterior surgical approaches to the elbow: a comparative anatomic study.J Shoulder Elbow Surg. 2001; 10: 380-382
- The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions.Orthop Clin North Am. 2000; 31: 91-101
- Extensor mechanism-sparing paratricipital posterior approach to the distal humerus.J Orthop Trauma. 2003; 17: 374-378
- A true triceps-splitting approach for treatment of distal humerus fractures: a preliminary report.J Trauma. 2005; 58: 70-75
- Outcome after open reduction and internal fixation of capitellar and trochlear fractures.J Bone Joint Surg Am. 2006; 88: 46-54
- Functional outcome after open supracondylar fractures of the humerus: the effect of the surgical approach.J Bone Joint Surg Br. 2000; 82: 646-651
- A morphological analysis of the humeral capitellum with an interest in prosthesis design.J Shoulder Elbow Surg. 2011; 20: 880-884
- Surgical elbow dislocation approach to the distal humerus for apparent capitellar and lateral condyle fractures in adults.J Orthop Trauma. 2021; 35: e77-e81
- Paratricipital-triceps splitting “two-window” approach for distal humerus fractures.Tech Hand Up Extrem Surg. 2011; 15: 156-161
- Elbow hemiarthroplasty using a “triceps-on” approach for the management of acute distal humeral fractures.J Shoulder Elbow Surg. 2015; 24: 1178-1186
- Functional outcome of AO type C distal humeral fractures.J Hand Surg Am. 2003; 28: 294-308
- Wound complications after distal humerus fracture fixation: incidence, risk factors, and outcome.J Shoulder Elbow Surg. 2014; 23: 258-264
- Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2–10) years.Acta Orthop Scand. 1992; 63: 85-89
- Distal humeral hemiarthroplasty: indications, results, and complications. A systematic review.Hand (N Y). 2014; 9: 406-412
- Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results.Shoulder Elbow. 2016; 8: 171-183
- The proximal ulna: an anatomic study with relevance to olecranon osteotomy and fracture fixation.J Shoulder Elbow Surg. 2003; 12: 293-296
- The bare area of the proximal ulna: an anatomic study with relevance to chevron osteotomy.J Hand Surg Am. 2017; 42: 471.e1-471.e6
- A posteromedial approach to the proximal end of the ulna for the internal fixation of olecranon fractures.J Trauma. 1969; 9: 594-602
- Surgical exposure of the ulna and proximal third of the radius through one incision.Surg Gynecol Obstet. 1940; 71: 87-88
- Brachialis insertion measurement: an anatomic cadaver study for plate fixation of the coronoid process fracture.Clin Anat. 2011; 24: 179-182
- Distal insertional footprint of the brachialis muscle: 3D morphometric study.Anat Res Int. 2015; 2015: 786508
- Dimensional accuracy and repeatability of the NextEngine laser scanner for use in osteology and forensic anthropology.J Archaeol Sci Rep. 2019; 25: 308-319
- Accuracy evaluation of a lower-cost and four higher-cost laser scanners.J Biomech. 2016; 49: 127-131
- Digastric olecranon osteotomy: feasibility study of a new approach to the elbow.Surg Radiol Anat. 2010; 32: 485-489
- Extra-articular step osteotomy of the olecranon: a biomechanical assessment.Clin Biomech (Bristol Avon). 2015; 30: 1043-1048
- Hemiarthroplasty of the distal humerus for acute and chronic complex intra-articular injuries.J Shoulder Elbow Surg. 2014; 23: 265-272
- Hemiarthroplasty for the treatment of distal humeral fractures: midterm clinical results.J Shoulder Elbow Surg. 2017; 26: 389-393
- Test-retest reproducibility of elbow goniometric measurements in a rigid double-blinded protocol: intervals for distinguishing between measurement error and clinical change.J Shoulder Elbow Surg. 2007; 16: 788-794
- Test-retest reliability of an active range of motion test for the shoulder and hip joints by unskilled examiners using a manual goniometer.J Phys Ther Sci. 2016; 28: 722-724
- Accuracy and reliability of knee goniometry methods.J Exp Orthop. 2018; 5: 1-6
Article info
Publication history
Published online: January 23, 2022
Accepted:
November 12,
2021
Received:
February 2,
2021
Footnotes
Dr Schemitsch received financial support from Stryker. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
Identification
Copyright
© 2021 by the American Society for Surgery of the Hand. All rights reserved.
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