Posterior Approach (Using Olecranon Osteotomy)

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.