Article

The traditional Kocher approach for lateral radial head exposure
may be complicated by injury to the deep branch of the radial nerve (DBRN) and
the radial collateral ligament. Kaplan approach is less commonly used, due to its
known proximity to the DBRN. Extensor Digitorum Communis (EDC) splitting approach
allows possible wide surgical exposure and low risk of radial collateral ligament
injury. The comparison of the proximity of the DBRN to the surgical dissection at
the level of radial head among approaches to the radial head has not previously
been evaluated. We aimed to determine the anatomical proximity of the DBRN in
these 3 common radial head approaches and to define a safe zone of dissection for
the surgical exposure. METHODS: Cadaveric dissections of 9 pairs of fresh frozen
upper extremities were performed using EDC splitting, Kaplan and Kocher approach
to the radial head sequentially in a randomized order. A mark was made on the
radial head upon initial exposure during dissection. Measurements from the marked
point of the radial head to the DBRN were made at the level of radial head.
RESULTS: The distance of DBRN to the radial head was 20 (17-22) mm in EDC
splitting approach, 7 (3-11) mm in Kaplan approach and 29 (25-33) mm in Kocher
approach. The EDC splitting approach was associated with a significantly lower
chance of encountering the DBRN at the level of radial head as compared to the
Kaplan approach (P<0.001). In all cases, lateral ligamentous complex was not
exposed in Kaplan and EDC approaches, but were encountered in Kocher approach,
risking injury to the radial collateral ligament. CONCLUSIONS: The EDC splitting
approach provides adequate exposure without the need to elevate or retract the
EDC and ECU muscle mass that could risk injuring the DBRN. 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 DBRN to the surgical
dissection at the level of the radial head. Caution of the DBRN should be taken
during anterior elevation and retraction of the muscle mass in Kocher approach.
LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2016 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS