Sophia Gogos BBMED, MBBS (Hons) , Rejith V. Mannambeth MS, FRCS, FRACS , Samuel T. Chee MBBS (Hons), MTrauma (Orth) , Ash K. Moaveni BHB, MBChB, FRACS, FAOrthA, MPH
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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.</div></div><div><h3>Results</h3><div>The anterior B-M approach visualized a significantly greater surface area of the coronoid process compared to the medial FCU-split (35.4 mm<sup>2</sup> vs. 12.8 mm<sup>2</sup>, <em>P</em> = .00). Both sex and side of limb did not independently affect the surface area of the coronoid exposed by either approach. 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引用次数: 0
摘要
背景：手术固定孤立的冠突骨折同时保持肘关节软组织的完整性是具有挑战性的。介绍了几种手术方法，每种方法都有自己的益处和风险。本尸体研究的目的是比较内侧尺侧腕屈肌（FCU）分离入路和肱前动脉和正中神经（B-M）入路对冠突的可见程度和进入程度。方法对17具尸体33份新鲜冷冻上肢标本进行解剖。两次手术暴露，fcu分裂和前路B-M间隔入路，按随机顺序对每个标本进行。记录了冠突解剖标志的可见性。取暴露的冠状面临床图像，用SketchAndCalc面积计算器软件分析暴露的总表面积。采用Medartis Aptus冠状钢板评估各入路螺钉孔进入的难易程度。结果前路B-M入路冠突表面积明显大于内侧fcu -劈开入路（35.4 mm2 vs 12.8 mm2, P = 0.00）。两种入路暴露的冠状面表面面积不受性别和肢体侧面的独立影响。前路入路更容易看到前内侧关节突和冠突尖端，通过FCU-split最容易看到结节和内侧副韧带后束。与内侧入路相比，前路入路进入标记为1的螺钉孔明显更容易，通过fcu -劈开进入4-10螺钉孔更容易。结论前路B-M入路比内侧fcu -劈开入路暴露冠突表面积大。虽然前路入路在冠突尖端的可视化方面表现出色，但内侧入路可能更容易获得多个螺钉置入选择。
Comparing the exposure of the ulna coronoid using the anterior or medial surgical approaches: a cadaveric study
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.
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