- Discussion:
    - considered to be the most versatile approach to the elbow;
    - most surgeons use straight longitudinal incision, which avoids olecranon tip, by shifting the incision slightly laterally or medially;

- Variations of Posterior Approach:
    - Transolecranon Osteotomy
           - indicated for condylar fractures;
           - can be intra-articular or extra-articular;
           - affords best visualization, of the distal articular fragments;
    - Triceps Splitting: (Urbaniak)
    - Tricpers Reflecting:
    - Caputo Technique:
           - indicated for extra-articular adult supracondylar fractures;
           - uses a standard posterior skin incision;
           - medial and lateral windows are created on either side of the triceps muscle;
           - medially, the ulnar nerve is carefully identified from its entrance between the two heads of the FCU up to a point cephalad to the arcade of Struthers;
                   - see: anatomy of the cubital tunnel;
                   - note that dissection proximal to the arcade of Struthers may injure the brachial artery;
           - laterally, the radial nerve is identified as it passes between the triceps and brachialis;
                   - the nerve can be found crossing this interval at a point just distal to the deltoid insertion;
           - once both nerves have been identified and protected, the medial and lateral borders of triceps is identified are dissected down to bone;
           - triceps can then be mobilized to either side to allow exposure to the medial and lateral sides of the distal humerus;

    - Modified Pediatric Approach:
           - posterior approach may be indicated for irreducible supracondylar frx (see open reduction) or for displaced lateral condyle frx;
           - posterior incision is made which curves along the medial side of olecranon;
           - ulnar nerve is identified and protected;
           - triceps tendon is transected 1 cm from its insertion (so that an adequate cuff of tendon is left for closure);
                   - remaining triceps insertion is elevated medially or laterally;
                   - the proximal portion of the tendon is mobilized proximally;
           - posterior capsule is opened transversely from medial to lateral;
           - the frx site is exposed and fixed appropriately;
           - triceps tendon is closed securely w/ non absorbable sutures;
           - arm is then immobilized in a cast (3 weeks for supracondyalr frx and 4-5 weeks for lateral condyle frx)

Alternative Operative Exposures of the Posterior Aspect of the Humeral Diaphysis with Reference to the Radial Nerve.

The triceps-dividing approach to open reduction of complex distal humeral fractures in adolescents: a Cybex evaluation of triceps function and motion.

The midline posterior elbow incision. An antomical appraisal.   

Outcomes Following Distal Humeral Fracture Fixation with an Extensor Mechanism-On Approach