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Orthopedic Surgery Ultimate > Elbow/Forearm Approaches > Flashcards

Elbow/Forearm Approaches Flashcards

1
Q

position for posterior approach to the elbow

A

prone

chest and abdomen free

tourniquet

abduct to 90°

sandbag under tourniquet

forearm hanging over table

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2
Q

incision for posterior approach to the elbow

A

begin 5 cm above olecranon laterally then as you cross the elbow curve medially and down the medial aspect of the ulna

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3
Q

internervous plane for posterior approach to the elbow

A

none

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4
Q

superficial dissection for posterior approach to the elbow

A

fascia midline

find ulnar nerve

V osteotomy of the olecranon about 2 cm from its tip with apex distal

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5
Q

deep dissection for posterior approach to the elbow

A

strip soft tissue from medial and lateral olecranon

retract proximally with triceps

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6
Q

danger for posterior approach to the elbow

A

1) ulnar nerve must be ID’d
2) median nerve lies anterior to distal humerus
3) radial nerve if you do too far proximal
4) brachial artery lies with median nerve
5) realign olecranon with great care after osteotomy

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7
Q

position for medial approach to the elbow

A

supine

arm on board in front of patient

elbow flexed at 90°

tourniquet

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8
Q

incision for medial approach to the elbow

A

8-10cm on the nedial aspect of the elbow centred on the medial epicondyle

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9
Q

internervous plane for medial approach to the elbow

A

proximally between brachialis and triceps

distally between brachialis and pronator teres

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10
Q

superficial dissection for medial approach to the elbow

A

palpate ulnar nerve

incise fascia

retract pronator teres anteriorly

expose common flexor origin

develop interval between pronator teres and brachialis (watch for median nerve)

retract ulnar nerve inferiorly

osteotomize the medial epicondyle and reflect distally

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11
Q

deep dissection for medial approach to the elbow

A

incise the capsule and medial collateral ligament to expose the joint

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12
Q

danger for medial approach to the elbow

A

1) ulnar nerve
2) median nerve - careful when retracting PT and the flexors

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13
Q

position for anterolateral approach to the elbow

A

supine

arm board

tourniquet

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14
Q

incision for anterolateral approach to the elbow

A

curved incision starting on lateral aspect of biceps 5 cm above the flexor crease that crosses to midline then down mid forearm along medial border of brachioradialis

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15
Q

internervous plane for anterolateral approach to the elbow

A

proximally between brachialis and brachioradialis

distally between brachioradialis and PT

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16
Q

superficial dissection for anterolateral approach to the elbow

A

ID LCNF

retract medially with medial skin flap

fascia along medial brachioradialis

ID radial nerve beneath it

develop plane between brachialis and brachioradialis

below division of radial nerve develop the plane between brachioradialis and lateral side of pronator teres

ligate recurrent branches of radial artery

retract radial artery medially with PT

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17
Q

deep dissection for anterolateral approach to the elbow

A

incise joint between radial nerve (lateral) and brachialis (medial)

supinate

incise origin of supinator

deissect subperiosteally just lateral to biceps insertion

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18
Q

danger for antrolateral approach to the elbow

A

1) radial nerve and its 3 branches in proximal forearm
2) PIN in supinator near neck of radius
3) LCNF - retract with skin medially
4) recurrent branches of radial artery must be ligated to mobilize the brachioradialis

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19
Q

position for anterior approach to the cubital fossa

A

supine

arm board

tourniquet

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20
Q

incision for anterior approach to the cubital fossa

A

start along medial border of biceps 5 cm proximal to flexor crease and cruve across cubital fossa to run down the medial aspect of brachioradialis

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21
Q

internervous plane for anterior approach to the cubital fossa

A

distally between brachioradialis and PT

proximally brachioradialis and brachialis

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22
Q

superficial dissection for anterior approach to the cubital fossa

A

fascia

ligate vessels

LCNF lies lateral

ID biceps aponeurosis and cut then reflect latrally

ID radial artery, median nerve, brachial artery, brachial vein

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23
Q

deep dissection for anterior approach to the cubital fossa

A

if you need to get to the joint from here, retract biceps and brachialis medially and brachioradialis laterally

supinate

incise origin of supinator and dissect to bone and retract laterally

incise capsule

24
Q

danger for anterior approach to the cubital fossa

A

1) LCNF - find between biceps and brachialis
2) radial artery lies immediately deep to bicipital aponeurosis
3) PIN vulnerable as it winds around the neck of radius within supinator

25
Q

position for posterolateral approach to the radial head

A

supine

arm over chest

pronate arm

tourniquet

26
Q

incision for posterolateral approach to the radial head

A

curved incision beginning over posterior surface of lateral epicondyle down medially across to posterior border of ulna about 6 cm long

27
Q

internervous plane for posterolateral approach to the radial head

A

between anconeus and ECU

28
Q

superficial dissection for posterolateral approach to the radial head

A

fascia

find interval between FCU and anconeus

detach part of anconeus origin

retract between these two muscles

29
Q

deep dissection for posterolateral approach to the radial head

A

pronate to move PIN away from field

incise capsule

30
Q

danger for posterolateral approach to the radial head

A

1) PIN is in the supinator and also on radial neck opposite the bicipital tuberosity
2) radial nerve - open joint laterally, not anteriorly

31
Q

position for anterior approach to radius

A

supine

arm board

supinate forearm

32
Q

incision for anterior approach to radius

A

lateral biceps tendon to radial styloid

33
Q

internervous plane for anterior approach to radius

A

between brachioradialis and FCR/PT

34
Q

superficial dissection for anterior approach to radius

A

fascia

find plane between BR and FCR/PT

ID superficial radial nerve under BR

ligate recurrent radial artery branches to BR

retract radial artery medially

35
Q

proximal deep dissection for anterior approach to radius

A

find tendon of biceps on radial tuberosity and incise

supinate forearm

incise supinator along radial insertion subperiosteally and retract laterally to protect PIN

36
Q

middle deep dissection for anterior approach to radius

A

pronate forearm to expose PT insertion and detach it subperiosteally and retract medial

37
Q

distal deep dissection for anterior approach to radius

A

supinate again

incise periosteum lateral to PQ insertion

retract PQ and FPL medially

38
Q

danger for anterior approach to the radius

A

1) PIN around neck of radius and within supinator
2) superficial radial nerve under brachioradialis
3) radial artery vulnerable during mobilization of brachioradialis and near the biceps tendon
4) recurrent radial arteries must be ligated to properly mobilize the brachioradialis

39
Q

position for approach to ulna

A

supine

arm on chest

tourniquet

40
Q

incision for approach to ulna

A

follow subcutaneous border of ulna where you need it

41
Q

internervous plane for approach to ulna

A

between ECU and FCU

42
Q

superficial dissection for approach to ulna

A

split some fibres of ECU usually necessary

43
Q

deep dissection for approach to ulna

A

develop plane epiperiosteally in the direction needed

may have to detach some triceps tendon in the proximal 5th of the incision

44
Q

dangers for approach to ulna

A

1) ulnar nerve travels throught the two head and then under FCU on FDP
2) ulnar artery travels just radial to the nerve

45
Q

position for posterior approach to the radius

A

supine

arm board

pronated

46
Q

incision for posterior approach to the radius

A

lateral epicondyle at elbow to lister’s tubercle

47
Q

internervous plane for posterior approach to the radius

A

ECRB and ED proximally

ECRB and EPL distally

48
Q

superficial dissection for posterior approach to the radius

A

plane through fascia between ECRB and ED

uncover upper 1/3 radius covered by supinator

then plane betwen ECRB and EPL distal to origin of AbPL and EPB

49
Q
A

ECRB

50
Q
A

EPL

51
Q
A

EPB

52
Q
A

AbPL

53
Q
A

ED

54
Q

proximal deep dissection for posterior approach to the radius

A

detach origin of ECRB and ECRL at lateral epicondyle and retract laterally

palpate PIN proximal to supinator and dissect out prox to distal

supinate

detach supinator subperiosteally

55
Q

middle deep dissection for posterior approach to the radius

A

incise superior and inferior borders of EPB and AbPL and retract depending on which direction is required

56
Q

distal deep dissection for posterior approach to the radius

A

separate ECRB and EPL to view radius

57
Q

danger for posterior approach to the radius

A

1) PIN - 25% of people have a PIN that touches the radius opposite the bicipital tuberosity - so protect it by stripping supinator subperiosteally

Orthopedic Surgery Ultimate (88 decks)

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