Transolecranon Surgical Approach for Radial Head Arthroplasty

The authors propose a novel surgical technique for complex fractures of the elbow necessitating a radial head arthroplasty (RHA) that spares additional soft tissue morbidity and allows for accurate sizing of the radial head. A 56-year-old woman presented with a transolecranon fracture-dislocation of the left elbow. Through a posterior transolecranon approach, there was excellent access to the intramedullary canal for insertion of a RHA to the proximal radius by reflecting the proximal ulna fragment cephalad and performing a shotgun maneuver that hyperflexes the elbow. Also, accurate sizing of the radial head was accomplished with direct visualization of its relationship with the lateral coronoid facet. The transolecranon approach avoids a separate lateral interval, such as the Kaplan or Kocher approach and their potential hazards, for placement of a RHA in complex elbow injuries. It also allows for accurate radial head sizing because of direct visualization of the relationship of the radial head with the lateral coronoid facet. During the past 5 years, the transolecranon approach has been used at the authors' institution for 6 RHAs for complex elbow injuries. These patients have not had postoperative dislocations or revisions. Additionally, no evidence of malsizing has been observed. [Orthopedics.2016; 39(5):e992-e996.].