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Collateral Ligament Release Improves Anterior Exposure of the Olecranon Osteotomy
Harrison Robert Ferlauto, MD
1; Christoph A Schroen, BS
1; Brian Beitler, MD
1; Katrina Nietsch, MS
1; James Dieterich, MD
1; Dave Shukla, MD
1; Jaehon Kim, MD
2; Michael R Hausman, MD
31Icahn School of Medicine at Mount Sinai, New York, NY; 2Orthopaedic Surgery, Mount Sinai School of Medicine, New York, NY; 3Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, NY
INTRODUCTIONIntraarticular distal humerus fractures with anterior articular involvement necessitate anatomic reduction and stable fixation to restore maximal elbow motion. However, traditional approaches to the elbow, such as the olecranon osteotomy, provide limited exposure of the anterior articular surface. To improve articular surface visualization following olecranon osteotomy, we have found it useful to also release, and later repair, the lateral ulnar collateral ligament (LUCL). The purpose of this study was to quantify the additional distal humerus articular surface exposure provided by LUCL release.
MATERIALS AND METHODSA standard olecranon osteotomy approach to the elbow was performed in 10 human fresh frozen cadavers. The elbow was maximally flexed and the margin of visible distal humerus articular surface was marked with ink. The LUCL was then released from its humeral origin, enabling the elbow joint to be booked open (Figure 1), and the additional region of visible articular surface was marked. The elbow was then disarticulated and the distal humerus excised en bloc. The region of articular surface initially visible after olecranon osteotomy alone was painted blue. The additional region visible after LUCL release was painted red (Figure 1). The articular surface of each specimen was scanned using a 3D scanner, and the area of the painted surfaces were quantified in square millimeters for three regions of interest: the total articular surface, the trochlea, and the capitellum. Raw surface area measurements were converted into percentages, and means and standard deviations were calculated across the 10 specimens.
RESULTSThe mean percent of total distal humerus articular surface, trochlear surface, and capitellar surface visible after olecranon osteotomy alone was 50.4 +/- 7.9%, 62.8 +/- 8.2%, and 20.3 +/- 7.9%, respectively (Figure 2). After olecranon osteotomy plus LUCL release, 100% of the total articular surface, trochlear surface, and capitellar surface were visible.
CONCLUSIONS The olecranon osteotomy provides exposure of the posterior 63% of the trochlea and posterior 20% of the capitellum. Supplementary LUCL release markedly improves exposure of the olecranon osteotomy, providing access to 100% of the distal humerus articular surface. Therefore, this technique may be useful for optimizing visualization and fixation of complex intraarticular distal humerus fractures involving the anterior articular surface.
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