Table 2.

Pearls and Potential Pitfalls of the Outerbridge-Kashiwagi Procedure

Pearls

•We avoid the use of burs for creation of the osteotomy to decrease the theoretical risk of heterotopic bone formation. •Fenestration of the olecranon fossa with a drill followed by excision bone with a mallet results in a controlled, safe, and precise osteotomy. •If positioning the patient supine, an assistant is needed to help position the limb during the procedure. If there are no assistants available to the surgeon, consider positioning the patient in the lateral decubitus position along with the use of a padded Mayo stand. •The triceps tendon is closed with the elbow held in 90° to avoid over tensioning of the triceps which may lead to elbow extension. •A soft dressing is used after surgery to allow for immediate range of motion.

Potential Pitfalls

•Avoid making skin incision directly posterior and over the olecranon tip. Incision curves slightly medial to avoid the olecranon tip. •Avoid being too medial with the skin incision and do not penetrate too deeply with the scalpel medial to the olecranon because the ulnar nerve is in close proximity. •Avoid damage to the cartilage when elevating soft tissue off of the posterior distal humerus. •Consider ulnar nerve transposition when treating and correcting excessive elbow contractures.