The anconeus approach is safe and effective for lateral elbow trauma: a consecutive case series of clinical and functional outcomes

To report on the clinical, functional, and radiographic outcomes after treatment of lateral elbow trauma using the anconeus approach.

This was a single-surgeon, retrospective case series conducted at an academic Level-I trauma center. Consecutive adult patients with radial head fractures, capitellum fractures, elbow fracture-dislocations, or olecranon fracture-dislocations who underwent treatment using the anconeus approach between 2016 and 2021. Functional outcomes evaluated using the Disabilities of the Arm, Shoulder and Hand score. Clinical outcomes evaluated for elbow/forearm range of motion, posterolateral rotatory instability (PLRI), and complications. Radiographic outcomes assessed with radiographs.

Nineteen patients met inclusion criteria. The mean age was 43.2 years (21-71), and 10/19 (52.6%) were male. Mean clinical follow-up was 11.9 months (range 3-25 months), and functional outcomes follow-up was 12.3 months (range, 4-25 months). The mean Disabilities of the Arm, Shoulder and Hand score was 9.1 (range, 0.0-29.3). Mean elbow range of motion was 112° (range, 60-140°), and mean forearm pronation-supination arc was 174° (range, 130-180°). No cases of synostosis, ankylosis, PLRI, or recurrent elbow dislocation were seen. Osteoarthritic changes were absent in 11 elbows, mild in 7, and moderate in 1. One patient developed nonunion of a radial head fracture. One patient underwent elective proximal ulna plate removal. There were no infections or cases of delayed wound healing. No patient had iatrogenic injury to the posterior interosseous nerve.

The anconeus approach is safe and effective. It resulted in excellent outcomes with a low rate of complications. It does not seem to contribute to iatrogenic PLRI.