Davos Courses

Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric proximal forearm

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Glossary

Posterior approach to the ulna

Introduction

Olecranon fractures can be addressed through a posterior midline skin incision curved slightly laterally around the tip of the olecranon.


Posterior approach - Skin incision enlarge

Skin incision

Start the incision a few centimeters proximal to the tip of the olecranon.

Curve it slightly laterally around the tip of the olecranon to prevent ulnar nerve injury and scar irritation when leaning on the elbow.

The incision may be extended as far distally as desired as the direct (subcutaneous) approach to the ulnar shaft.


Posterior approach - Dissection enlarge

Dissection

Incise the deep fascia in line with the incision to approach the dorsal border of the ulna directly.

Note: To access the tip of the olecranon it may be useful to split the triceps tendon.


Posterior approach - Dissection enlarge

Visualize the dorsal border of the olecranon and expose the proximal ulnar metaphysis between anconeus and flexor carpi ulnaris.


Posterior approach - Dissection enlarge

This provides good access to the ulnar aspect of the proximal ulnar metaphysis and can be extended to expose the ulnar shaft.


Wound closure

Reattach flexor carpi ulnaris and anconeus and repair the fascia with resorbable sutures.

Close skin and subcutaneous tissue with resorbable sutures.

If swelling or skin condition is a concern nonabsorbable sutures are acceptable.

v1.0 2019-08-19