title: Applied anatomical study of the modified anconeus flap approach.
abstract: OBJECTIVE
  Conventional surgical therapy for an intercondylar humerus fracture might result in multiple potential complications. Our study was conducted to evaluate the modified anconeus flap approach by adequately exposing the distal humeral articular surface, avoiding osteotomy of the olecranon and transection of the main part of the triceps brachial tendon from the olecranon.
  
  
  METHODS
  Preparations of 20 upper limb specimens from adult cadavers were used in this study. We investigated the anatomical features of the distal tendon of the triceps brachii. Then, we designed a modified anconeus flap approach in cadaver specimens combined with the medial paratricipital approach, and we compared the extent of exposure of the distal humeral articular surface between the triceps-reflecting anconeus pedicle approach and this modified approach.
  
  
  RESULTS
  The downward neurovascular bundles supplying the anconeus were located far from the intramuscular tendon of the triceps brachii. In addition, the medial head of the triceps was continuous with the anconeus near the lateral epicondyle of the humerus. These anatomical properties could assist in reducing adverse events in surgery. The percentage of the exposed humerus distal articular surface was 42.7% by applying the modified anconeus flap approach combined with the medial paratricipital approach. The modified anconeus flap approach can overcome the shortcomings of osteotomy or triceps transverse and fulfill reduction and internal fixation of most distal humerus intercondylar fractures.
  
  
  CONCLUSIONS
  The present study has demonstrated a new approach for adequately exposing the distal humeral articular surface during surgery for an intercondylar humerus fracture. With this modified approach, osteotomy of the olecranon and the separation or transection of the main part of the triceps brachial tendon from the olecranon are not necessarily required. Therefore, we suggest that this novel approach could be applied as the primary surgical approach in intercondylar humerus fracture surgeries if the surgeons are familiar with the regional features of distal tendon of the triceps brachii and anconeus.
authors.affiliation: Department of Anatomy and Boxi Institute of Clinical Anatomy, Medical College of Soochow University, Suzhou, 215123, China.|Department of Orthopedics, Yancheng Third People's Hospital, Yancheng, 224001, China.
authors.forename: Huan-jian
authors.initials: HJ
authors.lastname: Sun
authors.affiliation: Department of Anatomy and Boxi Institute of Clinical Anatomy, Medical College of Soochow University, Suzhou, 215123, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Anatomy and Boxi Institute of Clinical Anatomy, Medical College of Soochow University, Suzhou, 215123, China. xclcnb@suda.edu.cn.
authors.forename: Chun-lin
authors.initials: CL
authors.lastname: Xia
authors.affiliation: Department of Orthopedics, Yancheng Third People's Hospital, Yancheng, 224001, China.
authors.forename: Wen-feng
authors.initials: WF
authors.lastname: Zhu
authors.affiliation: Department of Orthopedics, Yancheng Third People's Hospital, Yancheng, 224001, China.
authors.forename: Jia-dong
authors.initials: JD
authors.lastname: Wu
mesh_terms: D000328:Adult; D002102:Cadaver; D004551:Elbow Joint / Q000033:anatomy & histology* / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000033:anatomy & histology* / Q000601:surgery; D056740:Olecranon Process / Q000033:anatomy & histology* / Q000601:surgery; D013524:Surgical Flaps
keywords: Anconeus; Applied anatomy; Intercondylar humerus fracture; Triceps brachii