Comparing the exposure of the ulna coronoid using the anterior or medial surgical approaches: a cadaveric study

Abstract

Background

Surgical fixation of isolated coronoid process fractures while maintaining the soft tissue integrity of the elbow joint is challenging. Several surgical approaches are described, each with their own benefits and risks. The purpose of this cadaveric study was to compare the extent of visualization and access to the coronoid process using the medial flexor carpi ulnaris (FCU)-split and anterior brachial artery and median nerve (B-M) approaches.

Methods

A total of 33 fresh frozen cadaveric upper limb specimens from 17 cadavers were dissected. Two surgical exposures, a FCU-split and anterior B-M interval approach, were performed on each specimen in a randomized order. The visibility of anatomical landmarks of the coronoid process was documented. Deidentified clinical images of the exposed coronoid were taken and the total surface area exposed was analyzed using SketchAndCalc Area calculator Software. The Medartis Aptus coronoid plate was used to assess the ease of screw hole access via each approach.

Results

The anterior B-M approach visualized a significantly greater surface area of the coronoid process compared to the medial FCU-split (35.4 mm² vs. 12.8 mm², P = .00). Both sex and side of limb did not independently affect the surface area of the coronoid exposed by either approach. The anteromedial facet and coronoid tip were more easily visualized using the anterior approach, with the sublime tubercle and posterior bundle of the medial collateral ligament seen best via the FCU-split. Access to screw hole labeled 1 was significantly easier using the anterior approach compared to the medial approach, with screws holes 4-10 more easily accessed through the FCU-split.

Conclusion

The anterior B-M approach provides significantly greater surface area exposure of the coronoid process compared to the medial FCU-split. While the anterior approach excels in visualization of the coronoid tip, the medial approach may provide easier access to multiple screw placement options.