Expanded Exposure of the Olecranon Osteotomy by Lateral Collateral Ligament Release.

Abstract

Purpose: Intra-articular distal humerus fractures with anterior articular involvement necessitate anatomic reduction and stable fixation to restore maximal elbow motion. However, traditional approaches to the elbow provide incomplete exposure of the distal humerus articular surface. To improve visualization of the capitellum and anterior trochlea, we have found it useful to supplement the olecranon osteotomy (OO) with a release, and subsequent repair, of the lateral ulnar collateral ligament (LUCL). The purpose of this study was to quantify and characterize the additional distal humerus articular surface exposure provided by LUCL release.

Methods: An OO approach was performed in 10 fresh frozen cadaver elbows. The margin of the distal humerus articular surface visible after OO was marked with ink. The LUCL was then released from its humeral origin and the additional region of visible articular surface was marked. The distal humerus was then excised. The region of the articular surface initially visible after OO alone was painted blue, and the additional region visible after LUCL release was painted red. The surface areas of the painted regions were quantified using a three-dimensional scanner.

Results: The mean percent of total distal humerus articular surface, trochlear surface, and capitellar surface visible after OO alone was 50.4 ± 7.9%, 62.8 ± 8.2%, and 20.3 ± 7.8%, respectively. After OO plus LUCL release, 100% of the total articular surface, trochlear surface, and capitellar surface was visible.

Conclusions: The OO is limited in that it only provides exposure of the posterior 63% of the trochlea and posterior 20% of the capitellum. Supplementary LUCL release significantly improves exposure of the OO, reliably providing access to the entire anterior articular surface of the distal humerus.

Clinical relevance: The expanded exposure of the OO by LUCL release may be useful for optimizing visualization and fixation of complex, intra-articular distal humerus fractures involving the anterior articular surface.