Surgical anatomy and technique for the treatment of Dubberley type 1, 2 and 3 capitellar fractures via a limited anterior approach to the elbow

Abstract

Coronal plane fractures of the elbow can affect the capitellum, the trochlea (or a combination of the two), the radial head and the coronoid processes.The Kocher lateral approach is the most commonly used for open reduction of this type of fractures, although an arthroscopic technique has been used in some cases. When the fracture extends to the trochlea, the Kocher lateral approach may be inadequate for the correct visualisation, reduction and fixation of the fracture. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. We think that the limited anterior approach to the elbow could be a valid option when treating these types of fractures, as it does not involve the de-insertion of any muscle group or ligament, thereby facilitating the recovery process. In cases involving trochlear fracture (which may or may not be dissociated) the approach can be extended medially. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. In the present study we describe the dissection of the medial and lateral cubital fossa of the elbow in extension in 4 specimens, paying attention to the neurovascular structures of the area. We also describe the surgical technique for the limited approach to the medial and lateral cubital fossa. We demonstrate the accessibility via the cubital fossa to the capitellum, trochlea, radial head, and coronoid process.