Abstract

Aim: The anterior approach to the elbow provides excellent visualization of coronoid process fractures; however, concerns regarding potential neurovascular injury have limited its widespread adoption. This cadaveric study aimed to identify consistent anatomical landmarks for the bifurcation of the radial nerve (RNB) and brachial artery (BAB) in relation to the transepicondylar axis (TEA), with the goal of improving the safety of the anterior elbow approach.
Materials and Methods: Fourteen fresh-frozen adult upper limbs obtained from seven cadavers were dissected. An S-shaped anterior incision was performed, and relevant neurovascular structures, including the radial nerve and brachial artery, were carefully identified. The transepicondylar axis was defined as the line connecting the medial and lateral epicondyles and was used as a reference landmark. Distances from the TEA to the radial nerve bifurcation into superficial and posterior interosseous branches and to the brachial artery bifurcation into the radial and ulnar arteries were measured using digital calipers.
Results: The mean length of the TEA was 57.12 mm. The radial nerve bifurcated at a mean distance of 19.34±2.06 mm proximal to the TEA (range, 17.20–22.27 mm). In contrast, the brachial artery bifurcated at a mean distance of 27.56±6.04 mm distal to the TEA (range, 21.48–35.47 mm). No statistically significant differences were observed between right and left extremities.
Conclusion: This cadaveric study provides precise anatomical reference points for key neurovascular structures encountered during the anterior approach to the elbow. The consistent location of the radial nerve bifurcation approximately 19 mm proximal to the TEA and the brachial artery bifurcation approximately 27.5 mm distal to the TEA may assist surgeons in safely and effectively performing coronoid fixation using the anterior elbow approach.

Key words: Anterior elbow approach, Radial nerve anatomy, Brachial artery anatomy, Surgical anatomy