Olecranon flip osteotomy for distal humerus fractures

Present the olecranon flip osteotomy approach for the treatment of distal humerus fractures as an alternative to the chevron osteotomy or previously described triceps-sparing approaches.

Distal humerus fractures requiring direct visualization of the articular surface.

Patient unfit for surgery.

A longitudinal skin incision starting 10 cm proximal to the olecranon tip is performed. The incision curves radially around the tip of the olecranon and continues distally, parallel to the ulnar crest. Identify and protect the ulnar nerve. Proximally a plane along the ulnar edge of the triceps muscle and tendon is developed, releasing the long head of the triceps from the medial intermuscular septum to gain access to the distal humerus. Distally the facia is dissected off the ulna. A thin chip of bone is elevated from the tip of the olecranon together with the triceps tendon and fascia allowing it to be flipped to the radial side. After dissecting the capsule and triceps off the humerus, the distal humerus can be visualized.

Immediate functional nonweight-bearing rehabilitation with no limitations regarding range of motion. Sling or splint for comfort during the first few days. Graduated weight-bearing after 6 weeks.

The authors have successfully applied the flip osteotomy in 12 cases, one of which was treated with a hemi-arthroplasty. All osteosyntheses achieved fracture healing and all patients acquired good elbow function after 3-6 months.