Posterior approach to the Elbow

Posterior approach using olecranon osteotomy

Indications

ORIF distal humerus
R/O Loose bodies
Nonunions

Position

Lateral
Padding under axilla

Landmarks

Olecranon process

Incision

10 cm Longitudinal midline incision along posterior aspect of elbow
curve it laterally around elbow

Internervous Plane

None
- As extensor mechanism is detached with osteotomy

Superficial Dissection

Deep fascia
Identify ulnar nerve
- Mobilise ulnar nerve from its bed & hold it free with vascular tape
Olecranon osteotomy
- Pre-drill & screw olecranon
- Score olecranon longitudinally
- V-shaped osteotomy about 2 cm from tip, apex directed distally

Deep Dissection

Elevate triceps from back of humerus
Subperiosteal dissection around medial & lateral borders of humerus as needed
Transpose ulnar nerve anteriorly

Dangers

Nerves
- Ulnar
- Radial
- Median
Vessels
- Brachial artery