No neurovascular damage after creation of an accessory anteromedial portal for arthroscopic reduction and fixation of coronoid fractures
- 95 Downloads
Arthroscopic reduction and internal fixation for coronoid process fractures has been proposed to overcome limitations of open approaches. Currently, arthroscopy is most frequently used to assist insertion of a retrograde guide wire for a retrograde cannulated screw. The present anatomical study presents an innovative arthroscopic technique to introduce an antegrade guide wire from an accessory anteromedial portal and evaluates its safety and reproducibility.
Six fresh-frozen cadaver specimens were obtained and prepared to mimic an arthroscopic setting. The coronoid process was localized and a 0.9 mm Kirschner wire was introduced from an accessory anteromedial portal, located 2 cm proximal to the standard anteromedial portal. At the end of the procedure, a lateral radiograph was taken to verify the Kirschner wire position and open dissection was conducted to evaluate possible damage to neurovascular structures.
The Kirschner wire was drilled without complications in the coronoid process of all six specimens. Damage of the brachial artery, the median nerve, and the ulnar nerve did not occur in any specimen. A corridor between the brachialis muscle, the median intermuscular septum, and the pronator teres could be identified as suitable for the wire passage.
This study presents a safe and reproducible technique combining the possibility to introduce a guide wire from the anteromedial part of the coronoid, under direct visual control, with a completely arthroscopic approach. This wire can guide the introduction of a retrograde cannulated screw from the dorsolateral ulna to the tip of the coronoid. This new arthroscopic approach permits to obtain improved visual control over coronoid process fixation, without endangering neurovascular structures.
KeywordsElbow Arthroscopy Cononoid Safety Fracture Fixation Anatomical study
PA: study design, surgical procedures, and manuscript correction; DC: study design, data collection, and original draft preparation; EG: surgical procedures; FL: data collection and figures; SN: surgical procedures; AM: statistical analysis; PR: manuscript correction.
This study was not funded.
Compliance with ethical standards
Conflict of interest
Author PA declares payment for development of educational presentations from Arthrex, outside the submitted work. Author DC declares that he has no conflict of interest. Author EG declares that he has no conflict of interest. Author FL declares that he has no conflict of interest. Author AM declares that she has no conflict of interest. Author SN declares that he has no conflict of interest. Author PR declares personal fees from Arthrex and Depuy (Johnson&Johnson), outside the submitted work.
Nicola’s Foundation & ICLO Research Center (ID10601).
Not required (cadaver study).
- 9.Gray H (1858) Anatomy. Descriptive and surgical. John W. Parker and Son, West strand, LondonGoogle Scholar
- 16.Malagelada F, Health B, Trust NHS, Quiron H (2015) Elbow anatomy. In Doral MN, Karlsson J (eds) Sport inj. Springer, Berlin, pp 1–30Google Scholar