Lateral epicondyle osteotomy for panoramic exposure of comminuted radial head fractures- a surgical technique guide.

Abstract

Comminuted radial head fractures pose technical challenges regarding visualisation and access for anatomical reduction and fixation. The traditional lateral 'window' approaches (Kocher, Kaplan and EDC split) can, at times, offer limited views and a more extensive exposure can be beneficial in comminuted patterns (Mason II/III). We present a lateral epicondyle osteotomy as an alternative for unobstructed views of the radial head to utilise for open reduction and internal fixation (ORIF). The patient is positioned supine with the operative arm on an arm board. A standard lateral skin incision centred over the radial head and lateral epicondyle is utilised. Both the Kaplan and Kochers interval are opened through deep dissection and the annular ligament is released. The lateral epicondyle is exposed using sharp dissection and a drill hole is made (for subsequent lag screw) either angled anteriorly to the coronoid fossa or posteriorly to the olecranon fossa. A chevron osteotomy is completed around the drill hole and the bone block along with attached common extensor origin and LUCL reflected distally to expose the radial head. The fracture stabilisation can then be performed and the osteotomy reduced and compressed through the pre drilled orientation. 2 cases are used to describe the use of a lateral epicondyle osteotomy for varied fracture patterns. In our experience the radial head is exposed with an unobscured exposure. All performed osteotomies have healed with good post operative DASH scores (average 31.65). No removal of metalwork has been required and patient satisfaction has been rated as high. Previously no literature has described the lateral epicondyle osteotomy in detail for accessing the radial head. Using our experience, through a lateral epicondyle osteotomy one can achieve a clear visualisation of the radial head and its articular surface without the need to strip fragments of its periosteum and blood supply, avoiding the need for removal and 'back table' reconstruction. It also prevents the need to detatch the LUCL complex and offers a more robust reconstruction with a reliable healing potential through an osteotomy.