No neurovascular damage after creation of an accessory anteromedial portal for arthroscopic reduction and fixation of coronoid fractures

Arrigoni, Paolo; Cucchi, Davide; Guerra, Enrico; Luceri, Francesco; Nicoletti, Simone; Menon, Alessandra; Randelli, Pietro

doi:10.1007/s00167-018-4926-2

Cited by 15 publications

(13 citation statements)

References 25 publications

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“…Regan and Morrey stratified the coronoid fractures based on the percentage of coronoid involvement and created a classification system, which is still currently widely used [10]. Herewith, contribution of the coronoid process against posterior, rotational and varus-valgus laxity could be quantified, suggesting that more than 50% height loss is associated with major elbow instability [5,9]. Nevertheless, static radiographic parameters have inherent limitations, as they cannot fully describe the complex joint stability status: for example, the rotation axis of the elbow is not a static constant, as it significantly shifts throughout the range of motion of the joint.…”

Section: Discussionmentioning

confidence: 99%

“…A linear correlation between progressive olecranon resection and varus-valgus and rotational instability was reported [8]. The height of the coronoid process plays a key-role against posterior, rotational and varus-valgus laxity and a bone loss of more than 50% is associated to major elbow instability [5,9].…”

Section: Introductionmentioning

confidence: 98%

“…Among the bony constraints, the ulnohumeral joint plays a primary stabilizing role, whereas the radio-humeral joint has only a secondary function. The biomechanical role of the coronoid process, which acts mainly as anterior support against posterior displacement of the ulna and forearm, has been thoroughly studied [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Luceri

Cucchi

Rosagrata

et al. 2021

IJOO

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Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Luceri

Cucchi

Rosagrata

et al. 2021

IJOO

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“…Work is ongoing to assess new anterior and anteromedial portals for antegrade fixation of coronoid fractures. [73,74] It must be stressed that these approaches have a much higher risk of neurovascular injury.…”

Section: Coronoidmentioning

confidence: 99%

Advances and future trends in elbow arthroscopy

Robinson¹

2020

JASSM

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Elbow arthroscopy has evolved since its inception and is now a commonly used technique in the diagnosis and treatment of elbow pathology. It has many indications, from the removal of intra-articular loose bodies to the management of elbow osteoarthritis and fractures. In this paper, we will discuss the full spectrum of elbow arthroscopy covering recent evidence, surgical techniques, advances, and future trends.

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“…For the median nerve, reliable landmarks have scarcely been reported, mostly by studies performed in arthroscopic settings and focused on defining anatomical relations at the level of the joint line, without investigating more distal regions. [13,17,18,[25][26][27][28][29]. Nevertheless, knowledge of median nerve position and behavior is essential in complex open surgery and revision cases and constitutes a precious help for all surgeons dealing with medial approaches, especially if lacking in a dedicated subspecialistic training on elbow surgery.…”

Section: Introductionmentioning

confidence: 99%

Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint

Cucchi

Luceri

Menon

et al. 2021

Arch Orthop Trauma Surg

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Introduction Preventing nerve injury is critical in elbow surgery. Distal extension of medial approaches, required for coronoid fracture fixation and graft-replacement, may endanger the median nerve. This study aims to describe an easily identifiable and reproducible anatomical landmark to localize the median nerve distal to the joint line and to delineate how its relative position changes with elbow flexion and forearm rotation. Materials and methods The median nerve and the ulnar insertion of the brachialis muscle were identified in eleven fresh-frozen cadaveric specimens after dissection over an extended medial approach. The elbow was brought first in full extension and then in 90° flexion, and the shortest distance between the two structures was measured while rotating the forearm in full pronation, neutral position and full supination. Results The distance between the median nerve and the brachialis insertion was highest with the elbow flexed and the forearm in neutral position. All distances measured in flexion were larger than those in extension, and all distances measured from the most proximal point of the brachialis insertion were larger than those from the most distal point. Distances in pronation and in supination were smaller than to those in neutral forearm position. Conclusions The ulnar insertion of the brachialis is a reliable landmark to localize and protect the median nerve at the level of the coronoid base. Elbow flexion and neutral forearm position increase significantly the safety margins between the two structures; this information suggests some modifications to the previously described medial elbow approaches. Level of evidence Basic Science Study.

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No neurovascular damage after creation of an accessory anteromedial portal for arthroscopic reduction and fixation of coronoid fractures

Cited by 15 publications

References 25 publications

Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Advances and future trends in elbow arthroscopy

Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint

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