Lateral para-olecranon approach: surgical guide and anatomical considerations to the anconeus branch: is there a nerve-free zone?

• Published in: European journal of trauma and emergency surgery (Munich : 2007) 2023-04, Vol.49 (2), p.875-884
• Main Authors: Plecko, Michael, Schwarz, Ulrike M., Hohenberger, Gloria M., Hammer, Niels, Schwarz, Angelika M.
• Format: Article
• Language: English
• Subjects: Critical Care Medicine; Elbow - surgery; Elbow Joint - surgery; Emergency medical care; Emergency Medicine; Humans; Humerus - surgery; Intensive; Male; Medicine; Medicine & Public Health; Muscle, Skeletal - surgery; Olecranon Process - surgery; Original; Original Article; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-022-02141-4

Purpose In the last decades, total elbow arthroplasty, elbow osteosynthesis and revision surgery have been more popularized. The study aimed to assess the course of the anconeus branch of the radial nerve in relation to two variations of the lateral para-olecranon approach, considering iatrogenic nerve injuries. Methods The study consisted of 120 upper extremities from 60 Thiel-embalmed human specimens. Two randomized versions of the lateral para-olecranon approach (centrally orientated: P1 and laterally orientated: P2) were performed. The olecranon and the intersection points to the anconeus branch of the radial nerve were determined as anatomical landmarks. The measurements were assessed by two independent observers. Differences were analyzed using the Student’s t test; associations were computed with the Pearson correlation ( r ). An alpha of 0.05 ( p ) and a confidence interval of 95% were set. Results The intersection points averaged 12.3 cm (SD 1.8, range 8.2–16.8) for P1 versus 5.5 cm (SD 1.4, range 3.0–9.2) for P2 ( p  ≤ 0.001). Statistically significantly higher values for male and longer humeral specimens were revealed (all values: p