- interneural interval: (Kocher's interval); 2015 Dec 23; 5(4): e30. - avoid injury to nerve, by not extending incision distally & avoid dissection beyond radial neck; Login to view comments. December 3-6, 2020, Hip periprosthetic fracture module is now online. Wheeless' Textbook of Orthopaedics. Lateral ... For a lateral skin incision, place the elbow at 90° and palpate the lateral condyle, which is easier in thin patients. 23:24. This interval permits safe access to the lateral elbow joint. - note: 1 cm of nerve translation can occur w/ forearm pronation and supination; - pronation will position PIN farthest away from surgical field; - Kocher Approach: - Elbow Flexion Contracture: - Discussion: - goal of procedure is elevation of common extensor tendon and transection of the anterior joint capsule; - indicated for significant flexion contractures (more than 30 deg) which arise from soft tissue (capsular contracture); - See: Lateral Approach - Discussion: - allows exposure of the entire distal humerus as well as radial head, radial neck, and biceps tuberosity; - indications for this approach include frxs of distal humerus, old posterior elbow dislocations, radial head frx, radial head excisions, arthroplasties, fixation of distal biceps tendon rupture, and resection of proximal radial-ulnar synostosis; The original Kocher approach was published several times in the 1892−1907 period. Kocher recommended a J shaped skin incision from the lateral supracondylar ridge to the subcutaneous ulna. - See: Kocher Approach to Elbow: - Discussion: - allows exposure of lateral column (for condylar frx), capitellum, and radial head, - it can also be used for Monteggia frx as well as for exposure for PIN decompression; - lateral approach is not optimal for complex low fractures of both columns (such as the transcondylar frx) of the distal end of the humerus; Towson, MD 21204 the anconeus and the ECU; The posterior interosseous nerve and the posterolateral approach to the proximal radius. For simple radial head replacement, See Modified posterior approach (Wrightington). - supine position: The Kocher interval is between the extensor carpi ulnaris and the anconeus. - alternatively the supinator should be released off of the ulnar border of the radius; - between the anconeus and the ECU; By Ed Bateman 19 Videos. as it passes distally to the dorsum of forearm; Kocher approach and Kaplan approach. Kocher Approach to the Elbow. Avoid dissection distal to the annular ligament or strenuous retraction because the posterior interosseous nerve, lying within the supinator muscle, is at risk. - keep this dissection in line with the fibers of the ECU (not the axis of the arm) inorder to preserve the fascial contributions of the ECU to the posterolateral ligamentous - main disadvantage is that visualization can be difficult; - Incision: - incise through the fascia overlying the anconeus and the ECU; Andrew Howard, Theddy Slongo, Peter Schmittenbecher. THE KOCHER APPROACH AND ITS VARIATIONS. May 14, 2014 3 Comments . - extended proximal exposure: Kocher approach and Kaplan approach. - at the distal end of the wound, the first PIN branches at risk are those to the ECU, which are 6 cm from the radial head; Kocher approach to the elbow and its options . The lateral Kocher/Kaplan approach can be used to access the radial head and the tip of the coronoid. Positioning . - PIN may be injured as it passes w/ in substance of supinator at level of radial tuberosity & continues to wind around shaft of radius - proximally define the interval between the triceps and ECRL / BR; - keep the arm pronated during this dissection in order to avoid injury to the PIN; - bluntly dissect through this interval and dissect down to the joint capsule; Kocher approach. - posterior border of common extensors is defined and is retracted anteriorly; - PIN is protected at this point by the ECU and EDC This has the advantage of being extensile, affording a full complement of surgical options as the exposure is extended. In pediatrics the most common use of this approach is open reduction of radial head/neck fractures. 2018 AWARD WINNER This video reports the authors' findings on the real anatomy of the lateral collateral ligament of the elbow and discusses how these findings affect decision making regarding the best surgical approach to the lateral elbow. For more extensive exposure of elbow consider global approach using Kocher interval. The Elbow Terrible Triad - Surgical Treatment 17:58. - incision over the radial head in line w/ the radius should avoid the LCL (avoids posterolateral instability); - allows exposure of the entire distal humerus as well as radial head, radial neck, and biceps tuberosity; - at this point the LCL should be exposed; 2. Click here to Login. Anatomical Understanding... Feat. - after the common extensors have been elevated anteriorly, posterior border of the supinator is identified; Davide Blonna. - realize that the fibers of the anconeus are fan shaped (horizontal-proximally and vertical distally); Avoid incising the capsule too far anteriorly as the radial nerve lies over the front of the anterolateral portion of the elbow capsule. Today this approach is described in the textbooks in various modifications that have little in common with the original description except for the fact that dissection is made in the so called Kocher interval between the extensor carpi ulnaris and the anconeus.
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