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Surgical Approach for Olecranon Frx

- See:
             - Posterior Approach:
             - Lateral Approach

- Position:
    - lateral w/ the arm abducted 90 deg;
    - force of gravity maintains the correct position;
    - sterile tourniquet is applied;
    - for simple fractures: supine with the arm laid across the chest;
    - the position must allow flexion and extension;

- Incision:
    - incision is started posteriorly above elbow, and continues distally, curving either ulnarly or radially to avoid point of
           olecranon, & then continue still distally towards the posterior border of ulna to a point 3-4 cm distal to frx;
           - ulnarly based incision is a better choice since it affords better exposure of ulnar nerve which may need to be transposed 
                     anteriorly at end of case;
           - a radial incision will require considerable underming;
    - olecranon bursa is incised and no effort is made to protect it;
    - aconeus is elevated on the lateral aspect of the ulna;
    - idenitify and preserve the radial and ulnar collateral ligaments;

- Frx Visualization and Reduction:
    - performed w/ elbow in extension which relaxes pull of triceps muscle;
    - frx site is visualized by elevating periosteum proximally w/ proximal fragment;
    - articular surface is visualized laterally and medially by elevating the triceps retinaculum and periosteum;
         - lateral exposure requires detachment of aconeus muscle from radial side of the ulna;
         - medial exposure risks ulnar nerve injury;
    - frx is reduced and held w/ one or two towel clips or K wires;
    - begin by drilling a superficial hole in the distal fragment to allow introduction of the tip of the pointed reduction forceps;
    - other tip of forceps catches proximal fragment & reduces fracture;

- Choice of Fixation:
    - Tension Band Wiring:
    - Plate Fixation