Posterior surgical approaches to the elbow: a comparative anatomic study

Area of Science:

• Orthopedic Surgery
• Anatomy

Background:

• Posterior surgical approaches to the adult elbow, including triceps splitting, triceps reflecting, and olecranon osteotomy, are commonly used.
• Comparative data on the exposure provided by these approaches are lacking.

Purpose of the Study:

• To compare the degree of distal humeral articular surface exposure provided by triceps splitting, triceps reflecting, and olecranon osteotomy.
• To determine the optimal posterior surgical approach for maximizing visualization of the distal humerus.

Main Methods:

• Four adult cadaveric elbows were used for each surgical approach.
• The visible articular surface was stained with methylene blue after each approach.
• The percentage of visible articular surface was measured after elbow disarticulation.

Main Results:

• The median exposed articular surface was 35% for triceps splitting, 46% for triceps reflecting, and 57% for olecranon osteotomy.
• Olecranon osteotomy provided significantly greater exposure than triceps splitting (P =.03).
• Olecranon osteotomy did not significantly differ from triceps reflecting in exposure.

Conclusions:

• Olecranon osteotomy provides the greatest exposure of the distal humeral articular surface among the evaluated posterior elbow approaches.
• Despite being the best option, olecranon osteotomy still fails to provide visualization of more than 40% of the articular surface.
• Further research may be needed to identify approaches that offer more comprehensive visualization.