Abstract
Background
The traditional Kocher approach for lateral elbow exposure is often complicated by injury to the posterior interosseous nerve (PIN) and the lateral ulnar collateral ligamentous (LUCL). Kaplan approach is less commonly used, due to its known proximity to the PIN. Extensor Digitorum Communis (EDC) splitting approach allows possible wide surgical exposure and low risk of LUCL damage. The comparison of PIN injury during surgical dissection among these 3 common lateral approaches was not previously evaluated. We aim to determine the anatomical proximity of the PIN in these 3 common lateral elbow approaches and to define a safe zone of dissection for the surgical exposure.
Methods
Cadaveric dissections of 9 pairs of fresh frozen adult upper extremities were performed using EDC splitting, Kaplan and Kocher approach to the radial head sequentially in a randomised order. The radial head and PIN were exposed. A mark was made on the radial head upon the initial exposure during dissection. Measurements from the marked point of the radial head to the PIN were made. Study has been approved by the ethics committee.
Results
The EDC splitting approach is associated with a significantly lower chance of encountering the PIN along the entry of dissection to reach the radial head as compared to the Kaplan approach. The Kocher approach has a lower chance of encountering the PIN along the entry of dissection to reach the radial head as compared to both Kaplan and EDC splitting approach.
Conclusions
The EDC splitting approach provides adequate exposure without injury to the lateral ligamentous complex nor need to elevate or retract the EDC and ECU muscle mass that could risk injuring the PIN. The Kaplan approach should be done by experienced surgeons who are familiar with the anatomy in this region, with extreme caution due to proximity of the point of entry to the PIN.
Level of evidence
IV
