Comparison of Exposure in the Kaplan Versus the Kocher Approach in the Treatment of Radial Head Fractures

Oct 28, 2026

Background: This study compares the complete visible surface area of the radial head, neck, and coronoid between the Kaplan and Kocher approaches for lateral elbow exposure. Methods: Ten cadavers were dissected using both approaches, with in situ measurements collected via a 3-dimensional digitizer; six measurements per approach were taken by two surgeons and analyzed using the mean. Results: With the LCL preserved, Kaplan showed 616.6 mm2 versus 136.2 mm2 for Kocher; Kocher with LCL incised showed 456.1 mm2. Conclusions: The Kaplan approach provides significantly greater visible surface area of the proximal radius than the Kocher approach.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Introduction

Materials and Methods

Specimen preparation and dissection approach

Surgery Article Comparison of Exposure in the Kaplan Versus the Kocher Approach in the Treatment of Radial Head Fractures Leslie Fink Barnes 1, Joseph Lombardi2, Thomas R. Gardner2, Robert J. Strauch2, and Melvin P. Rosenwasser2 HAND 1–6 © The Author(s) 2018 Reprints and permissions: [sagepub.com/journalsPermissions.nav](sagepub.com/journalsPermissions.nav)[ ](sagepub.com/journalsPermissions.nav)[DOI: 10.1177/1558944717745662](DOI: 10.1177/1558944717745662)[ ](DOI: 10.1177/1558944717745662)[hand.sagepub.com](hand.sagepub.com) Abstract Background: The aim of this study was to compare the complete visible surface area of the radial head, neck, and coronoid in the Kaplan and Kocher approaches to the lateral elbow. The hypothesis was that the Kaplan approach would afford greater visibility due to the differential anatomy of the intermuscular planes. Methods: Ten cadavers were dissected with the Kaplan and Kocher approaches, and the visible surface area was measured in situ using a 3-dimensional digitizer. Six measurements were taken for each approach by 2 surgeons, and the mean of these measurements were analyzed. Results: The mean surface area visible with the lateral collateral ligament (LCL) preserved in the Kaplan approach was 616.6 mm2 in comparison with the surface area of 136.2 mm2 visible in the Kocher approach when the LCL was preserved. Using a 2-way analysis of variance, the difference between these 2 approaches was statistically significant. When the LCL complex was incised in the Kocher approach, the average visible surface area of the Kocher approach was 456.1 mm2 and was statistically less than the Kaplan approach. The average surface area of the coronoid visible using a proximally extended Kaplan approach was 197.8 mm2. Conclusions: The Kaplan approach affords significantly greater visible surface area of the proximal radius than the Kocher approach. Keywords: coronoid, elbow, radial head, Kaplan approach, Kocher approach, posterior interosseous nerve Introduction In the treatment of radial head and neck fractures, the modified Kocher approach and the Kaplan approach are the 2 most common approaches used for access to the lateral elbow.3 The Kocher approach centers on the posterolateral elbow and exploits the oblique interval between the anconeus and the extensor carpi ulnaris (ECU) .12 The standard Kocher approach involves incision of the lateral collateral ligament (LCL) to gain access to the radial head. However, the modified Kocher approach preserves the lateral ulnar collateral ligament (LUCL) by anterior retraction of the ECU. A capsulotomy can be then made anterior to the LUCL in order to preserve this important structure.8,9,13 For distal extension of this approach, the radial collateral liga ment (RCL)–annular ligament complex must be incised. The Kaplan approach starts more anterior to the Kocher interval, between the extensor digitorum communis (EDC) and the extensor carpi radialis brevis (ECRB) .11 This allows a capsulotomy through the annular ligament anterior to the RCL-LUCL complex as well as distal extension without further compromise to the LCL and without extensive retraction. Despite these advantages to the Kaplan approach, some surgeons prefer to avoid it due to the proximity of the posterior interosseous nerve (PIN) .2,6,18,22 The radial head is the most commonly fractured element in the adult elbow, and the fracture fragments are often anterior.20 The radial head becomes a critical factor in elbow stability, especially if the coronoid is fractured as in the case of a terrible triad injury. Likewise, the coronoid is increasingly important for stability as other soft tissue and bony constraints are compromised around the elbow. 15,19 Therefore, coronoid fractures often need to be addressed concurrently with radial head fractures. If the radial head isnot excised, access to the coronoid can be challenging. Alternative approaches, such as a separate medial incision, ind

FAQs

What was the primary goal of the study?

To compare the visible surface area of the radial head, neck, and coronoid between the Kaplan and Kocher approaches for lateral elbow treatment.

How were the visible areas measured?

Ten cadavers were dissected using each approach, and visible surface area was measured in situ with a 3-dimensional digitizer.

What were the main findings when the LCL was preserved in each approach?

The Kaplan approach showed a much larger mean visible surface area (616.6 mm2) than the Kocher approach (136.2 mm2) with LCL preserved.

Oct 28, 2026

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