Posterior Approach (Using Olecranon Osteotomy)

Olecranon osteotomy in a cadaver elbow
Olecranon osteotomy in a cadaver elbow. A V shaped cut is made about 2 cm from the olecranon tip, and reflecting the olecranon with triceps exposes the articular surface of the distal humerus. Image from Liu Y, Gao Y, Xu X, Zhao Y, Wang H, Sun Q, Zhao B, Wang S, Zhou J. Elbow dislocation approach for complex elbow fractures, a cadaveric study. J Orthop Surg Res. 2023, 18(1), 978. CC BY 4.0.
Posterior Approach (Using Olecranon Osteotomy), radiograph of a distal humerus fracture after fixation
Radiograph of a distal humerus fracture after fixation. Image by Mehlauge, Wikimedia Commons, Public domain.

Indications

Position

  • Lateral
  • Arm over radiolucent L bar
  • Padding under axilla

Landmarks

  • Olecranon process

Incision

  • 10 cm longitudinal midline incision along posterior aspect of elbow
  • Curve laterally around elbow to avoid ulnar nerve

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

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.