- See:
Posterior Approach to the Humerus;
- Positioning:
- patient is in lateral position w/ arm brought across the chest;
- plan on adusting flexion of elbow inorder to increase or decrease tension;
- sterile tourniquet is required;
- Technique:
- straight longitudinal incision beginning 7-10 cm above posterior aspect
of humerus, avoiding the olecranon tip by shifting the incision slightly
medially, and then continue the incision over the border of the ulna;
-
ulnar nerve:
- expose
triceps fascia and
ulnar nerve as it courses into the
cubital tunnel;
- proximall the ulnar nerve is found at medial margin of triceps
lying in epineural fat;
- dissect the ulnar nerve distally to its first motor branch;
- proximally identify and remove the intermuscular septum;
- it is then translocated anteriorly into a SubQ pocket;
- instead of splitting the triceps, define the medial aspect of the triceps,
and reflect it laterally;
- elevate medial aspect of triceps from humerus to level of joint capsule;
- distally incise the fascia along the medial aspect of the olecranon,
and proximal ulna;
- raise a full thickness "apron" of periosteum, fascia, and triceps insertion from
a medial to a lateral direction, until the majority of the olecranon is exposed;
- as the apron of tissue is reflected laterally, attempt to include
the posterior joint capsule;
- distally the aconeus can be elevated off the ulna;
- the medial 1/3 to medial 1/2 of the triceps insertion may be elevated from
the tip of the olecranon;
- the entire triceps is elevated off the posterior humerus;
- wound closure include proximal reattachment of the triceps insertion into
crossing drill holes into the olecranon, and more distally anchoring
the periosteum to the superficial forearm fascia;
- deep forearm fascia is then securely closed to prevent ulnar subluxation;
