Detachment of Extensor Carpi Ulnaris and Anterior Branches of the Radial Collateral Ligament from the Epicondyle: A Modification of Kocher Lateral Approach for the Treatment of Radial Head Fractures
21 March 2018
07 August 2019
11 October 2019 (online)
Purpose The aim of this study is to present clinical results of a retrospective case series that includes patients treated with an extensive modification of the Kocher lateral approach to the elbow with surgical detachment of the anterior branches of the radial collateral ligament.
Methods From January 2016 to January 2018, nine patients with closed isolated displaced or multifragmentary radial head fractures (Mason type II, III, or IV) who underwent osteosynthesis or arthroplasty through a modified Kocher lateral elbow approach were available for follow-up.
Results There were six female and three male patients. The median age at the time of surgery was 52 years old (range: 26–70). The dominant upper limb was injured in 22.2% of patients. After a median follow-up of 8 (range: 6–27) months, all patients regained completely all their daily activities and no cases of infections were recorded.
Conclusion We believe that the approach proposed can be a useful choice to deal with these challenging injuries. Our strategy may represent a valid alternative to more popular approaches as the use of anchors decreases the risk of instability that is the major danger considered in the past when soft tissues as tendons and ligaments are detached.
Level of Evidence This is a level IV study (therapeutic case series).
- 1 Cheung EV, Steinmann SP. Surgical approaches to the elbow. J Am Acad Orthop Surg 2009; 17 (05) 325-333
- 2 Bartoníček J, Naňka O, Tuček M. [Kocher approach to the elbow and its options]. Rozhl Chir 2015; 94 (10) 405-414
- 3 Han F, Lim CT, Lim JC, Tan BH, Shen L, Kumar VP. Deep branch of the radial nerve in lateral surgical approaches to the radial head - a cadaveric study. Orthop Traumatol Surg Res 2016; 102 (04) 453-458
- 4 Han F, Teo AQ, Lim JC, Ruben M, Tan BH, Kumar VP. Outcomes using the extensor digitorum communis splitting approach for the treatment of radial head fractures. J Shoulder Elbow Surg 2016; 25 (02) 276-282
- 5 Desloges W, Louati H, Papp SR, Pollock JW. Objective analysis of lateral elbow exposure with the extensor digitorum communis split compared with the Kocher interval. J Bone Joint Surg Am 2014; 96 (05) 387-393
- 6 Stroyan M, Wilk KE. The functional anatomy of the elbow complex. J Orthop Sports Phys Ther 1993; 17 (06) 279-288
- 7 Hackl M, Bercher M, Wegmann K, Müller LP, Dargel J. Functional anatomy of the lateral collateral ligament of the elbow. Arch Orthop Trauma Surg 2016; 136 (07) 1031-1037
- 8 Giannicola G, Polimanti D, Bullitta G, Sacchetti FM, Cinotti G. Critical time period for recovery of functional range of motion after surgical treatment of complex elbow instability: prospective study on 76 patients. Injury 2014; 45 (03) 540-545