Purpose: The purpose of this study is to describe an anterolateral portal technique to the capitellum and to investigate its anatomic relationship nearby neurovascular structures in the elbow.
Methods: The study included 6 arm-to-fingertip adult cadavers. The demographic information of the cadavers was recorded. We initially dissected the elbows using a lateral approach to the capitellum. Next, a 1.5-cm anterolateral portal to the radiocapitellar joint was made and tagged with heavy suture and passed through the lateral elbow wound, with the elbow and forearm in an extended, supinated position. We then dissected out neurovascular structures around the elbow and measuring the distance of each structure to our tagged anterolateral portal. The structures identified included the lateral antebrachial cutaneous nerve (LABCN), cephalic vein, basilic vein, radial nerve, posterior interosseus nerve (PIN), radial sensory nerve, brachial artery, and median nerve.
Results: 3 males and 3 female cadavers with average age 77 years old (66 – 88 years old) were included. The radial nerve was the structure closest to our portal at 2.6-mm +/- 1.4-mm on average (range 1 – 4.4-mm) . The LABCN and Cephalic vein were the next closest structures at 7.5-mm +/- 6.2 (1 – 18-mm) and 7.3-mm +/- 7.7 (1 – 22 .3-mm) respectively . The PIN and radial sensory nerve were distal and radial to our portal at a distance of 10.5-mm +/- 6.1 (1.8 – 17.2 mm) and 10.8-mm +/- 5 9 (1.8 – 17.2-mm) respectively. The brachial artery and median nerve were medial to our portal at a distance of 19.7 mm +/- 7.3 (12 – 31.4-mm) and 22.3-mm +/- 10.0 (14.3 – 42.1-mm) respectively.
Conclusions: The radial nerve is the closest to our described accessory anterolateral portal . Careful dissection is needed to avoid intramuscular dissection of the brachioradialis. The brachial artery and median nerve are relatively safe in this technique.
