Clinicoanatomic study of optimal arthroscopic approaches to the elbow

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Abstract

The purpose: development and topographic substantiation of optimal arthroscopic approaches to the elbow, taking into account the location of the neurovascular structures in different functional positions. Material and methods: Anatomical relationships of elbow nerves and bony structures were studied by dissection of non-fixed anatomical material (6 elbow joints). To investigate the variant anatomy of the brachial artery, MRI in 23 patients were performed. In 10 patients the authors used ultrasound to study the topographic relationships of elbow nerve structures at different functional positions of the upper extremity Variability of the brachial artery deviation, depending on the angle of elbow flexion, was studied in six angiograms of non-fixed anatomical material. Statistical analysis was performed using Instant + and Past 306 software. Results: It was found that elbow flexion of 180°-90° moves the brachial artery away from the bones with a maximum distance from the humerus of 5 cm above the joint space. Distance increases from 23.5±3.1 mm to 23.9±3.1 mm. In 90° elbow flexion radial and median nerves are at the maximum distance from bony structures - 16.01±0.43 and 20.48±0.28 mm, respectively. Conclusion: These findings allowed justification of the conclusion that the lateral arthroscopic approaches to the elbow are the safest. It is possible to perform two lateral arthroscopic approaches: optical and instrumental, without conflict with major neurovascular structures. The optimal position for the surgery is 90° elbow flexion.

About the authors

I. A. Kuznetsov

Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov Northwestern State Medical University

Author for correspondence.
Email: noemail@neicon.ru
Russian Federation

N. F. Fomin

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

M. R. Salikhov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: virus-007-85@mail.ru
Russian Federation

G. I. Zhabin

Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov Northwestern State Medical University

Email: noemail@neicon.ru
Russian Federation

D. A. Shulepov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

S. A. Bantser

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

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