ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

As for any surgical procedure, the first step in obtaining a successful result is the optimal placement of a skin incision to facilitate the deep surgical approach for the execution of the operation. The posterior skin incision has emerged as the superficial skin approach for most elbow operations. The indications and technique for the superficial surgical approaches to the elbow are reviewed.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

It is becoming increasingly known that effective interventions at the elbow require a comfort with and an adequate execution of exposures of all parts of the elbow. A posterior skin incision allows this exposure by developing medial and lateral flaps. The key to an adequate exposure consists in this management of the triceps mechanism. The various options, including osteotomy of the olecranon and splitting and reflecting of the triceps, are summarized herein.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The term “lateral approach” to the elbow refers to the deep course of dissection and exposure and is independent of the skin incision chosen. Advantages include simplicity of exposure with no requirement for dissection of important neurovascular structures. The lateral approach offers flexibility in exposure with the ability to extend a limited approach into a widely extensile exposure when needed. Indications include fractures of the radial head, capitellum, and intra-articular distal humerus; lateral tennis elbow debridement; repair or reconstruction for posterolateral rotatory instability; release of elbow contracture or debridement of primary or post-traumatic arthritis; radial head resection or replacement; and replacement or resurfacing arthroplasty.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The anterior approach to the elbow provides excellent exposure of the anterior capsule, the anterior aspect of the proximal radioulnar joint and the anterior aspect of the collateral ligament complexes. When performing the approach care must be taken to identify and protect the neurovascular structures that lie immediately in front of the elbow. The primary indication for the approach is to perform an anterior capsular release or resection to treat a flexion contracture caused by capsular hypertrophy with a normal or near-normal joint structure. Other indications include repair of the distal biceps tendon, exploration of the neurovascular structures and resection of heterotopic ossification. The approach is not ideal for intra-articular procedures. The approach is contra-indicated if there is extensive scarring anteriorly that would prevent safe identification and protection of the neurovascular structures. The anterior approach continues to have a role in reconstructive elbow surgery, although its role has decreased since the advent of arthroscopic procedures and the widespread use of more utilitarian approaches such as the lateral and posterior approaches.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Exposure for total elbow arthroplasty can be challenging. Various different approaches that have been described have advantages and disadvantages.The triceps split technique offers several advantages over other common approaches to elbow arthroplasty with respect to maintenance of the soft tissue envelope, the sequential ability to release collateral ligaments, and the ability to extend the approach both proximally and distally.The author's experience with the triceps split technique for total elbow arthroplasty has been an addition to his armamentarium in approaching the elbow and now is his preferred method to approach most cases treated with total elbow arthroplasty.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Effective restoration of triceps function is an essential prerequisite of extensile posterior exposures to the elbow. Reflecting the triceps from the olecranon in one form or other is today termed “triceps reflecting technique.” The original such description is summarized in this article. Variations have included a fleck of olecranon attachment with the reflected triceps as well as reflecting the extensor mechanism along with the anconeus from lateral to medial. In any instance, meticulous reattachment is necessary to fully utilize the effectiveness of this approach.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The triceps anconeus pedicle (TRAP) approach involves reflecting the triceps and anconeus proximally, much like an olecranon osteotomy, by combining medial Bryan-Morrey and lateral modified Kocher approaches. It has a number of advantages and disadvantages. The main advantages of the TRAP approach are that it avoids hardware complications and olecranon nonunion and does not potentially contribute to post-traumatic arthritis or intra-articular adhesions. In addition, the TRAP approach permits total elbow arthroplasty and open reduction and internal fixation through the same exposure. This is especially important in very comminuted fractures in elderly patients, in which adequate reduction and fixation may not be possible. By retaining the entire olecranon intact, one can use the olecranon, coronoid, and radial head as a three-dimensional template against which to assemble the articular fragments until adequate provisional fixation is obtained.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Displaced radial head fractures can be successfully treated with open reduction and internal fixation in many cases. Radial head fractures that are too comminuted or osteoporotic to achieve stable internal fixation should be treated with alternative techniques, such as radial head excision or radial head arthroplasty. Exposure of the radial head and neck, without compromise of elbow stability, can be obtained by the method described in this article.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Recognition of the important role of the coronoid process to the stability of the elbow has contributed to a greater interest in internal fixation of coronoid fractures. Large fractures are usually associated with olecranon fracture-dislocations and smaller fractures with terrible triad injuries or lateral collateral ligament injury (varus posteromedial rotatory instability). Large fractures can often be visualized and realigned through the olecranon that cannot be addressed through the olecranon fracture alone. All of the approaches are made through a midline posterior skin incision. Anteromedial facet fractures (common among varus posteromedial rotatory instability and posterior Monteggia injuries) may be best treated with a small anterior plate applied through the medial exposure.

ISSN:1523-9896    

出版商:OVID    

年代:2002

数据来源: OVID