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Selected Publication:
Schwarz, U.
The Paraolecranon Approach for Total Elbow Arthroplasty and Complex Fracture Management: Is the Anconeus Branch Safe?
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 62
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- Authors Med Uni Graz:
- Advisor:
- Hammer Niels
- Hohenberger Gloria
- Altmetrics:
- Abstract:
- Introduction The paraolecranon approach has become increasingly important for prosthetic replacements of the elbow joint or the treatment of distal humerus fractures. The nerve innervating the anconeus muscle is at risk for iatrogenic injury during posterior surgical approaches to the elbow. The objective of this study was to investigate the course of the anconeus nerve branch through the triceps muscle in relation to two versions of the paraolecranon approach and determine the location of an iatrogenic injury and a safe zone for the nerve. Methods 120 upper extremities of 60 human adult body donors, that were embalmed using Thiel’s method, were investigated during the study. Two modified versions of the paraolecranon approach (POA 1 and POA 2) were defined and carried out sequentially on each upper extremity. The distance between anatomical landmarks on the olecranon and the anconeus nerve was measured in alignment with the approaches. Statistical analysis was performed to determine a possible difference between the approaches and whether side, sex, or humerus length affected the course of the nerve in relation to the approaches. Results Regarding the course of the anconeus nerve branch in relation to the two paraolecranon approaches, a significant difference between the approaches was found (p≤0.001). The distance between the respective landmark and the nerve branch was longer for the more medially located POA 1 (distance 12.3 cm) compared to the more laterally located POA 2 (distance 5.5 cm). The side did not influence the extent of the safe zone. The study showed statistically significant longer distances for male specimens when compared to females and longer distances for longer humerus bones. Conclusion The more medially located paraolecranon approach (POA 1) resulted in a wider safe zone for the nerve. Therefore, the use of this approach may reduce the risk of iatrogenic nerve injury.