Effectiveness of anconeus flap approach in the treatment of radial head fractures

Objective To design anconeus approach based on the anatomical features of anconeus, and explore its application in the surgical treatment of radial head fractures. Methods Twenty adult cadaver upper limb specimens were dissected. The anatomic features and techniques of anconeus flap were studied, and the proximal radius, humeroradial joint and proximal radioulnar joint were exposed. Open reduction and internal fixation of 26 cases of radial head fracture was done via the anconeus flap approach. Results The medial collateral artery and anconeus branch of the radial nerve entered the anconeus along the medial head of triceps and anconeus in a proximal to distal direction. Dissecting and lifting the anconeus in a distal to proximal direction provided wide view of radial head and neck, humeroradial joint and proximal radioulnar joint without damaging the blood supply and innervation of the anconeus flap. The 26 patients treated with this approach were follow-up for 12 to 24 months with an average of 18.6 months. At the final follow-up assessment the Mayo elbow performance scoring system was used to evaluate patient′s elbow function. An average of 92.5 points was reached, with an overall 90.6% satisfactory rate. Conclusion The anconeus flap approach provides good exposure of the surgical field in the treatment of radial head fracture. Postoperative recovery is ideal, without elbow instability, flexor muscle weakness, elbow muscle atrophy and other complications. Key words: Radius fractures; Treatment outcome; Surgical approach; Anconeus flap