The osteo-anconeus flap. An approach for total elbow arthroplasty

Twenty-seven consecutive primary total elbow arthroplasties were done with a technique that preserved the continuity of the attachment of the triceps brachii muscle with a wafer of bone from the reflected extra-articular portion of the olecranon and with the lateral fascia of muscles of the forearm. During closure, the wafer was reattached to the broad cancellous surface of the olecranon with sutures through the bone. The elbows were immobilized for an average of sixteen days postoperatively. The patients who were available for follow-up were re-examined at an average of 3.9 years, and the strength of the triceps muscle was checked. No extensor lag or avulsion of the triceps occurred, and mild extensor weakness was seen in only two elbows. No patient had early or late drainage of the wound or infection. The average range of motion compared favorably with that in other reported series. This osteo-anconeus posterior approach is advocated for total elbow arthroplasty because it provides rapid and wide exposure, it is associated with a low rate of complications related to the wound, and it preserves the strength of the triceps.