Valgus stability, posterolateral stability and
longitudinal stability are determined using commonly
accepted practices such as preoperative radiographs,
intraoperative inspection, and stress radiographs
Surgical Approach
After the skin incision is performed (Figure
1), the radial head is exposed via a modified
lateral approach designed to preserve the lateral
ligaments
The approach splits the thick common extensor
tendon origin in the midline
Exposure
The appropriate plane can be identified by palpating
the lateral condylar ridge and radial head
A full-thickness incision is made through the
common tendon and ligament origin along the longitudinal
axis of the radial head and neck (Figure 2)
The origin of the radial wrist extensors and
the joint capsule may be elevated from the anterolateral
aspect of the distal humerus as needed for exposure
Extend the split of the lateral complex distally
to the metaphysis of the radial neck. In the atraumatic
setting, the exposure can be performed without
destabilizing the elbow since the posterior half
of the extensor origin and lateral ligament complex
remain intact.
NOTE: When the radial
head has fractured in association with a dislocation
of the elbow, the lateral complex will often be
stripped from its
origin on the lateral epicondyle. This should be
noted during the exposure, and a plan should be
formulated to repair or reconstruct the complex
at the end of the case.
