Triceps Splitting Approach to the Elbow



- See: Posterior Approach to the Humerus;

- Discussion:
    - the distal triceps can be split down the middle with the dissection carried straight down to bone over the olecranon;
    - care is taken to mobilize full thickness fascial and periosteal flaps both medially and laterally;
    - the dissection may procede all the way to the epicondyles if necessary;
    - as Urbaniak notes, if care is taken to elevate full thickness flaps (and care is taken to obtain a secure closure), then triceps avulsion is not a 
          major problem;

- Positioning:
    - patient is in lateral position w/ arm brought across the chest;
    - plan on adusting flexion of elbow inorder to increase or decrease tension;
    - sterile tourniquet is required;

- Technique:
    - indicated for condylar fractures;
    - disadvantages: detachment of the medial triceps insertion is a potential complication, which has led some to routinely use the medial triceps 
           reflecting approach;
    - straight longitudinal incision beginning 7-10 cm above posterior aspect of humerus, avoiding olecranon tip by shifting incision either 
          slightly laterally or medially;
    - proximally incise thru the medial triceps fascia, continue across the olecranon, and finally across the lateral aspect of ulna;
    - longitudinally incise thru triceps tendon, and subperiosteally reflect aconeus laterally, more distally the FCU is reflected and retracted 
          medially;
    - proximally the radial nerve will be encountered in the spiral groove, approximately 13-15 cm above the joint line;
    - distally the incision continues over the lateral border of the ulna;
    - preserve as much of the triceps insertion as possible (up to 3/4 of the insertion can be sharply elevated off the ulna;;
    - further exposure can be achieved by removing the most proximal portion of the olecranon process (removing only the non articular 
          portion of the olecranon);
    - wound closure include proximal reattachment of the triceps insertion into crossing drill holes into the olecranon, and more distally 
          anchoring the periosteum to the superficial forearm fascia



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, September 12, 2011 2:26 pm