Lateral Elbow Exposures: The Extensor Digitorum Communis Split Compared with the Kocher Approach.

INTRODUCTION

In comparison with the frequently used modified Kocher approach, the extensor digitorum communis (EDC) splitting approach allows improved access to the anterior half of the radial head, which is most commonly fractured, while reducing the risk of iatrogenic injury to the lateral collateral ligament.

STEP 1 MAKE THE INCISION MODIFIED KOCHER APPROACH: Make an oblique 7-cm lateral incision beginning at the proximal edge of the lateral epicondyle and extending distally over the center of the radial head toward the posterior ulnar border of the extensor carpi ulnaris muscle belly.

STEP 2 DEVELOP THE INTERVAL BETWEEN THE ANCONEUS AND THE EXTENSOR CARPI ULNARIS: Identify and develop the intermuscular interval between the anconeus and the extensor carpi ulnaris.

STEP 3 PERFORM THE LATERAL ELBOW CAPSULOTOMY: Longitudinally incise the lateral elbow capsule and annular ligament anterior to the lateral ulnar collateral ligament.

STEP 4 THE EXTENDED MODIFIED KOCHER APPROACH: Extend the exposure by elevating the common extensor origin (extensor carpi radialis brevis, EDC, and extensor carpi ulnaris) proximally off the lateral epicondyle and reflect it anteriorly.

STEP 5 MAKE THE INCISION EDC SPLITTING APPROACH: Make a longitudinal oblique 5 to 6-cm lateral incision beginning at the proximal edge of the lateral epicondyle and extending distally over the radial head toward the Lister tubercle.

STEP 6 IDENTIFY AND SPLIT THE EDC: The EDC tendon is identified and bisected longitudinally starting proximally at its origin on the lateral epicondyle and extending 20 mm distally from the radiocapitellar joint.

STEP 7 PERFORM THE LATERAL ELBOW CAPSULOTOMY: The annular ligament and joint capsule are then incised collinear with the EDC split anterior to the equator of the capitellum.

STEP 8 EXTENDED EDC SPLITTING APPROACH: Extend the exposure by detaching the anterior half of the EDC tendon and the extensor carpi radialis brevis tendon from the lateral epicondyle.

STEP 9 LAYERED CLOSURE: Perform an interrupted layered closure.

RESULTS

In our recent cadaveric study, we quantitatively compared the modified Kocher and EDC splitting approaches in order to determine which provided the greatest exposure of the anterior aspect of the radial head, which is most commonly fractured.IndicationsContraindicationsPitfalls & Challenges.