Medial Approach via Osteotomy

Indications

• ORIF
  • Coronoid process
  • Medial condyle & epicondyle

Contraindications

• Exploration of elbow
• Access to lateral side

Position

• Supine
• Arm board
  • Shoulder fully ER
  • Elbow flexed to 90°
• Prep & drape arm free

Landmarks

• Medial epicondyle

Incision

• 10 cm longitudinal incision centred over medial epicondyle

Internervous Plane

• Proximally
  • Brachialis
    • Musculocutaneous nerve
  • Triceps
    • Radial nerve
• Distally
  • Brachialis
    • Musculocutaneous nerve
  • Pronator teres
    • Median nerve

Superficial Dissection

• Locate ulnar nerve
  • Mobilise & hold free with vascular tape
• Identify & develop the plane between pronator teres & brachialis
  • Being careful not to damage the median nerve anteriorly
  • Gently retract pronator teres medially

Deep Dissection

• Ensure the ulnar nerve is protected
• Osteotomy of medial epicondyle
• This exposes the joint capsule

Dangers

• Nerves
  • Ulnar
  • Median