Surgical Approach to the Ulna


- See:
         - Blount Fracture: Both Bone Forearm Fracture
         - Plating Techniques

- Position:
    - arm is placed on an upholstered armboard w/ medium elbow flexion and full arm pronation;

- Surgical Approach:
    - interneural approach: lies between ECU (PIN) & FCU (ulnar nerve);
    - ECU muscle often extends past the posterior midline of the ulna and it must be divided to reach the bone;
    - note that FDP originates over the majority of volar aspect of the ulna, and that volar stripping will elevate the FDP;
    - distal exposure:
            - incision begins over ulnar styloid & extends proximally along crest of ulna for approximately 12.5 cm;
            - deep fascia and periosteum are incised in a similar line;
            - ECU is retracted laterally, & FCU is retracted medially;
    - proximal exposure:
            - incision of approx 15 cm long is made, extending from tip of olecranon process tot he desired point on the forearm;
            - post deep fascia & periosteum are cut down onto ulna between anconeus, supinator, & ECU laterally & FCU medially;

- Plate Position: (see: plate menu)
    - whether plate is applied anteriorly or posteriorly is not important;
    - choose the surace on which it fits best;
    - posterior surface is good choice, since this is tension side;
    - when frx is comminuted on either of these surfaces, placing plate on side of  most comminution is usually better because plate will then stabilize the loose fragments;
    - note that FDP originates over the majority of volar aspect of the ulna, and that volar stripping will elevate the FDP;
           - if a volar approach of Henry is used to fix the radius then there will at least some stripping of the FDP, and therefore consider placing the ulnar plate on the dorsal side inorder to avoid further stripping of the FDP origin;
                   - over stripping of the FDP origin can lead to finger stiffness and prolonged need for hand therapy;            

- Hazzard:
    - ulnar nerve lies proximally under the flexor carpi ulnaris and on flexor digitorum profundus;
    - it should be preserved w/ proximal dissection



Anatomic considerations for anterior approaches to the ulna.

Soft tissue attachments of the ulnar coronoid process. An anatomic study with radiographic correlation.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, December 12, 2012 10:44 am