Tips and Techniques in Elbow Surgery by Unknown

Author:Unknown
Language: eng
Format: epub, pdf
ISBN: 9783031080807
Publisher: Springer International Publishing

Step 11: The first goal should be to establish a view. This might not be easy due to interposition of parts of the capsule; the shaver must therefore be immediately brought into contact with the camera, under almost visualization. In the next step, as much capsule as necessary should be removed in front of the camera to permit inspection.

Step 12: Fifth standard portal = distal posterolateral (soft spot) portal (Fig. 21.3).

The third posterior portal is used to evaluate the radiohumeral joint and the posterior proximal radioulnar joint. The portal is within the soft spot. As usual, a needle is inserted under arthroscopic visualization. It should be placed in the lateral inferior recess.

Step 13: Additional posterior portal = distal ulnar portal (Fig. 21.6).

Arthroscopic surgery has become the standard procedure to treat capitellar OCD [7]. Access to the capitellum has to be ensured to debride these lesions. The standard portals will not enable exact access, so another portal, the distal ulnar portal, is needed. It is placed 3–4 cm distal to the edge of the ulna. After skin incision the trocar is advanced under the anconeus, along the lateral edge of the ulna and directed diagonally toward the radio-capitellar joint, passing behind the radial head into the joint. By flexing the elbow progressively to 90° or more, direct visualization and access to the capitellum is obtained, permitting all sorts of therapeutic measures, e.g., microfracturing.

Multiple Choice Questions

1.

Which nerves are most endangered during elbow arthroscopy?Ulnar nerve (x)*

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