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Plecko, M; Schwarz, UM; Hohenberger, GM; Hammer, N; Schwarz, AM.
Lateral para-olecranon approach: surgical guide and anatomical considerations to the anconeus branch: is there a nerve-free zone?
Eur J Trauma Emerg Surg. 2023; 49(2):875-884 Doi: 10.1007/s00068-022-02141-4 [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz
Plecko Michael
Schwarz Angelika
Co-Autor*innen der Med Uni Graz
Hammer Niels
Hohenberger Gloria
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Abstract:
PURPOSE: In the last decades, total elbow arthroplasty, elbow osteosynthesis and revision surgery have been more popularized. The study aimed to assess the course of the anconeus branch of the radial nerve in relation to two variations of the lateral para-olecranon approach, considering iatrogenic nerve injuries. METHODS: The study consisted of 120 upper extremities from 60 Thiel-embalmed human specimens. Two randomized versions of the lateral para-olecranon approach (centrally orientated: P1 and laterally orientated: P2) were performed. The olecranon and the intersection points to the anconeus branch of the radial nerve were determined as anatomical landmarks. The measurements were assessed by two independent observers. Differences were analyzed using the Student's t test; associations were computed with the Pearson correlation (r). An alpha of 0.05 (p) and a confidence interval of 95% were set. RESULTS: The intersection points averaged 12.3 cm (SD 1.8, range 8.2-16.8) for P1 versus 5.5 cm (SD 1.4, range 3.0-9.2) for P2 (p ≤ 0.001). Statistically significantly higher values for male and longer humeral specimens were revealed (all values: p < 0.05). Comparison of left and right sides yielded no difference. Excellent inter-rater agreements were found (ICC = 0.902, range 0.860-0.921). A correlation was evaluated between the humeral length and the distances in both approaches (P1: r = 0.550, p < 0.001, P2: r = 0.669, p < 0.001). CONCLUSION: The data presented here allow preservation of the anconeus branch. The P1 forms a potential advantage by owing a broader safe zone. Using the centrally orientated approach seems to provide adequate nerve protection during surgery for one of the motor branches for extension of the elbow joint and might result in improved postoperative benefits.
Find related publications in this database (using NLM MeSH Indexing)
Male - administration & dosage
Humans - administration & dosage
Elbow Joint - surgery
Olecranon Process - surgery
Elbow - surgery
Humerus - surgery
Muscle, Skeletal - surgery

Find related publications in this database (Keywords)
Lateral para-olecranon approach
Anconeus branch
Triceps-on approach
Distal humeral fracture
Total elbow arthroplasty
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