Comparison of blind surgical zone in the Henry vs. Kocher approach in the treatment of partial radial head fractures

Abstract

Background: The Kocher approach is often adopted for surgical treatment of partial radial head fractures. However, anterior exposure of the radial head is limited by the Kocher approach. Radial head fractures are predisposed to be located at the anterior radius. The deviation of susceptible fracture locations against the regular operative approach imposes certain challenges on surgical procedures. This study explored whether there are any clinically significant differences in the exposure between the Henry and Kocher approaches. Materials and methods: Ten fresh-frozen cadaveric upper limbs were obtained as specimens. The radial head was exposed by both the Henry and Kocher approaches, followed by a long-axis parallel incision at the joint capsule until the capsular attachment was reached; the extracapsular ligaments and surrounding soft tissues were avoided. The 2 approaches were compared in the blind zone and in the visualized area. Results: The blind-zone arc of radial head exposure with the Henry and Kocher approaches averaged 132° ± 16° and 112° ± 21°, respectively. The supinated angle between the borderline of the blind-zone arc and the biceps tuberosity–radial medullary cavity centerline averaged 268° ± 20° and 75° ± 16°, respectively. Conclusions: The Henry approach offered optimal exposure of the anterior and lateral radial head but had a blind zone at the posteromedial radial head, whereas the Kocher approach offered optimal exposure of the posterolateral radial head but had a blind zone at the anterolateral radial head. The Henry approach could be a better option for specific management of radial head fractures based on the fracture location.

Keywords

• Partial radial head fractures
• Henry approach
• Kocher approach
• blind surgical zone
• trauma
• elbow