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Posterior Approach to the Elbow


- See: Posterior Approach to the Humerus;

- 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)

The posterior approach to the elbow revisited.

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