The cubital (anticubital) fossa is a triangular-shaped depression over the anterior aspect of the elbow joint. Representing an area of transition between the anatomical arm and the forearm, it conveys several important structures between these two areas. It is triangular in shape and consists of three borders, a roof, and a floor. The cubital fossa is also a passageway for structures to pass between the upper arm and forearm.
The cubital fossa has three borders, a roof and a floor, which are as follows:
The contents of the cubital fossa are in order from lateral to medial:
The roof of the cubital fossa also contains several superficial veins, most notably the median cubital vein, which connects the basilic and cephalic veins and can be accessed easily as a common site for venepuncture.
A supracondylar fracture is a fracture of the distal humerus. It is typically transverse or oblique in shape and the most common mechanism of injury is falling on an outstretched hand. It is more common in children than adults. In this type of injury, the contents of the cubital fossa can be damaged - either directly, or by soft tissue swelling following the trauma.
Damage to the brachial artery, if not repaired, can cause Volkmann's ischaemic contracture (uncontrolled flexion of the hand) as the forearm flexor muscles become fibrotic and short. There can also be damage to the anterior interosseous nerve (a branch of the median nerve), ulnar nerve or radial nerve. The anterior interosseous nerve can be tested by asking the patient to make an ‘OK’ sign, testing for weakness of flexor pollicis longus.
The Gartland classification is used for these fractures and is divided into four types:
Type 1 can usually be managed conservatively with an above elbow cast, whereas types 2 and 3 typically require surgical fixation with crossed, bi-cortical k-wires. In more severe cases, such as type 4, radial head replacement may be necessary.
The cubital fossa is an important area of transition between the anatomical arm and the forearm, where several important structures pass between these two areas. Its contents provide crucial information for doctors to diagnose and appropriately treat a wide range of elbow injuries such as supracondylar fractures.
A supracondylar fracture is a fracture of the distal humerus, and is more commonly seen in children than adults. The fracture is typically transverse or oblique in nature and is caused by a fall onto an outstretched hand. In this type of injury, the structures of the cubital fossa - found at the distal end of the anterior forearm - may be affected, either directly or through soft tissue swelling due to the trauma. If not timely repaired, damage to the brachial artery can cause Volkmann’s ischaemic contracture, which is characterized by uncontrolled flexion of the hand due to fibrosis and shortening of the forearm flexor muscles. The anterior interosseous nerve - a branch of the median nerve - can also be damaged together with the ulnar nerve and the radial nerve. This can be tested by asking the patient to make an ‘OK’ sign and assessing any weakness of the flexor pollicis longus.
The Gartland classification system is commonly used for supracondylar fractures. Type 1 fractures are minimally displaced and can usually be managed conservatively with an above elbow cast; in contrast, types 2 and 3 fractures are displaced with an intact posterior cortex and completely off-ended, respectively, and typically require surgical fixation with crossed, bi-cortical k-wires.
The cubital fossa, also known as the anatomical cubital fossa, cubital triangle, or Inferior cubital fossa, is a shallow depression on the anterior view of the elbow joint located between the slender medial and lateral borders. It is divided into two compartments - superficial and deep - and contains the structures of the medial and lateral epicondyles of the humerus, the brachial artery, and the median and ulnar nerves. Knowledge of the cubital fossa, its contents, and borders is essential for clinical relevance, especially when dealing with a supracondylar fracture, injury to the motor/sensory function of the elbow, or venepuncture. The Gartland classification is used to categorise supracondylar fractures of the humerus based on the presence of vascularity.
While conservative management through casting is an option for certain types of supracondylar fractures, it is important to assess the extent of the damage in order to provide the most appropriate treatment option for the patient. Damage to the structures of the cubital fossa, such as the brachial artery and the nerves, can have serious consequences if not immediately addressed and may result in muscular atrophy and tissue death. Therefore, it is important to have a thorough understanding of the anatomy of the cubital fossa and the Gartland classification system to properly diagnose and treat supracondylar fractures.
The cubital fossa is often a site of trauma, particularly in children who are at higher risk of supracondylar fractures due to their seemingly increased exposure to falls. It is therefore important for orthopaedic doctors, surgeons, and other healthcare professionals to be familiar with the anatomy and potential complications of the cubital fossa. This knowledge will ensure that the patient receives the most appropriate and timely treatment while avoiding the unneccessary complications of Volkmann's ischaemic contracture and muscle atrophy.
The Gartland classification system is a useful tool for orthopaedic doctors, as it helps to categorise supracondylar fractures and determine the best course of action for treatment. Type 1 fractures can usually be managed with casting, whereas type 2 and 3 fractures require surgical intervention with k-wires for fixation. In order to accurately diagnose and treat a supracondylar fracture, it is important to understand the anatomy of the cubital fossa, its contents, and its potential complications. This knowledge can help healthcare providers to ensure prompt and appropriate treatment which can ultimately lead to better and more favourable outcomes for the patient.
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