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

  • Paolo Arrigoni
  • Davide Cucchi
  • Enrico Guerra
  • Francesco Luceri
  • Simone Nicoletti
  • Alessandra Menon
  • Pietro Randelli
Elbow
  • 95 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Elbow Arthroscopy Cononoid Safety Fracture Fixation Anatomical study 

Notes

Author contributions

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.

Funding

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.

Ethical approval

Nicola’s Foundation & ICLO Research Center (ID10601).

Informed consent

Not required (cadaver study).

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.1° Clinica OrtopedicaAzienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTOMilanItaly
  2. 2.Laboratory of Applied Biomechanics, Department of Biomedical Sciences for HealthUniversità degli Studi di MilanoMilanItaly
  3. 3.Department of Orthopaedics and Trauma SurgeryUniversitätsklinikum BonnBonnGermany
  4. 4.Shoulder and Elbow UnitIstituto Ortopedico RizzoliBolognaItaly
  5. 5.U.O. Clinica Ortopedica e Traumatologica Universitaria CTOAzienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTOMilanItaly
  6. 6.Università degli Studi di MilanoMilanItaly
  7. 7.Azienda USL Toscana Centro—Sede: Ospedale San JacopoPistoiaItaly

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