Fucai Han1, Alex Quok An Teo2, Jia Chen Lim2, Manohara Ruben2, Bryan Hsi Ming Tan2, V Prem Kumar3. 1. Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore. Electronic address: fucai_han@nuhs.edu.sg. 2. Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore. 3. Department of Orthopaedic Surgery, University Orthopaedics, Hand & Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Abstract
BACKGROUND: Surgery on the radial head is usually performed via the Kocher interval. Iatrogenic injury to the posterior interosseous nerve (PIN) and lateral ligamentous complex are known complications of lateral elbow approaches. The extensor digitorum communis (EDC) splitting approach for lateral elbow exposure is known to provide better access to the anterior half of the radial head while reducing the risk of injury to the lateral ligaments. The aim of this study was to provide clinical outcome data for the EDC splitting approach. METHODS: Thirteen patients with closed radial head fractures underwent internal fixation or replacement via the EDC splitting approach. Patients were evaluated using the Mayo Elbow Performance, American Shoulder and Elbow Surgeons (ASES), and Disabilities of Arm, Shoulder and Hand scores. Clinical assessments of the elbows were also performed. RESULTS: Ten patients underwent open reduction and internal fixation of their radial heads, and 3 underwent radial head replacements. At final follow-up, all patients achieved good to excellent Mayo Elbow Performance scores, with a mean score of 90 (range 80-100). They had a mean ASES elbow score of 89.6 (range 77-97) and a mean Disabilities of Arm, Shoulder and Hand score of 12.8 (range 6.67-25.8). Patients reported a mean overall ASES satisfaction score of 8.5 (range 6-10). There were no significant surgical complications, including iatrogenic damage to the PIN or the lateral ligaments. CONCLUSION: The EDC splitting approach is a feasible method of exposing the lateral elbow, providing safe and reliable access to the radial head.
BACKGROUND: Surgery on the radial head is usually performed via the Kocher interval. Iatrogenic injury to the posterior interosseous nerve (PIN) and lateral ligamentous complex are known complications of lateral elbow approaches. The extensor digitorum communis (EDC) splitting approach for lateral elbow exposure is known to provide better access to the anterior half of the radial head while reducing the risk of injury to the lateral ligaments. The aim of this study was to provide clinical outcome data for the EDC splitting approach. METHODS: Thirteen patients with closed radial head fractures underwent internal fixation or replacement via the EDC splitting approach. Patients were evaluated using the Mayo Elbow Performance, American Shoulder and Elbow Surgeons (ASES), and Disabilities of Arm, Shoulder and Hand scores. Clinical assessments of the elbows were also performed. RESULTS: Ten patients underwent open reduction and internal fixation of their radial heads, and 3 underwent radial head replacements. At final follow-up, all patients achieved good to excellent Mayo Elbow Performance scores, with a mean score of 90 (range 80-100). They had a mean ASES elbow score of 89.6 (range 77-97) and a mean Disabilities of Arm, Shoulder and Hand score of 12.8 (range 6.67-25.8). Patients reported a mean overall ASES satisfaction score of 8.5 (range 6-10). There were no significant surgical complications, including iatrogenic damage to the PIN or the lateral ligaments. CONCLUSION: The EDC splitting approach is a feasible method of exposing the lateral elbow, providing safe and reliable access to the radial head.
Keywords:
Direct lateral approach to elbow; clinical outcomes; extensor digitorum communis splitting approach; posterior interosseous nerve; radial head fracture