Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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The original Kocher approach was published several times in the 18921907 period. It extends in the interval between the extensor carpi ulnaris and the anconeus and consists in subperiostal release of the lateral collateral ligament (LCL), joint capsule and origin of extensors at the lateral epicondyle and their retraction anteriorly, and a similar release of the anconeus from the distal humerus and its reflection posteriorly. This provides an extensive approach to the elbow. ⋯ This eliminates the risk of injury to the neurovascular hilus of the muscle, as the motoric nerve enters the muscle in the middle of its upper border. Retraction of the muscle exposes both the lateral surface of the joint capsule and the lateral surface of the proximal ulna. Further procedure, i.e. incision of the capsule and inspection of the joint, is the same as in the limited Kocher approach.
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Radius is a critical bone for functioning of the forearm and therefore its reconstruction following fracture of its shaft must be anatomical in all planes and along all axes. The method of choice is plate fixation. However, it is still associated with a number of unnecessary complications that were not resolved even by introduction of locking plates, but rather the opposite. ⋯ When drilling screw holes the drill must be directed into the interosseous border. As a result, the screw has the longest trajectory and the best fixation in the bone. Perforation of the anterior or posterior surface of the radius considerably shortens the trajectory of the screw and thus reduces stability of internal fixation.