Posterior Surgical Approaches to the Elbow: a Comparative Anatomic Study

Triceps splitting, triceps reflecting, and olecranon osteotomy are the most common posterior surgical approaches to the adult elbow, but no comparative data exist as to the exposure provided by each approach. The aim of this study was to determine which of these approaches provides the greatest exposure of the distal humeral articular surface. Each approach was performed on 4 adult cadaveric elbows. After the completion of each approach, the visible articular surface was painted with methylene blue. The elbow was then disarticulated, and the percentage of articular surface visible was measured. The median exposed articular surface for the triceps splitting, triceps reflecting, and olecranon osteotomy approaches was 35%, 46%, and 57%, respectively. Olecranon osteotomy exposed more articular surface than the triceps splitting approach (Mann-Whitney test, P =.03) but was not significantly greater than the triceps reflecting approach. However, even the olecranon osteotomy approach failed to provide visualization of more than 40% of the distal humeral articular surface.