- See:
Posterior Approach to the Humerus;
- Discussion:
- the distal triceps can be split down the middle with the dissection carried straight down to
bone over the olecranon;
- care is taken to mobilize full thickness fascial and periosteal flaps both medially and laterally;
- the dissection may procede all the way to the epicondyles if necessary;
- as Urbaniak notes, if care is taken to elevate full thickness flaps (and care is taken to obtain a
secure closure), then triceps avulsion is not a major problem;
- Positioning:
- patient is in lateral position w/ arm brought across the chest;
- plan on adusting flexion of elbow inorder to increase or decrease tension;
- sterile tourniquet is required;
- Technique:
- indicated for
condylar fractures;
- disadvantages: detachment of the medial triceps insertion is a potential complication,
which has led some to routinely use the medial triceps reflecting approach;
- straight longitudinal incision beginning 7-10 cm above posterior aspect of humerus,
avoiding olecranon tip by shifting incision either slightly laterally or medially;
- proximally incise thru the medial triceps fascia, continue across the olecranon, and
finally across the lateral aspect of ulna;
- longitudinally incise thru triceps tendon, and subperiosteally reflect
aconeus
laterally, more distally the
FCU is reflected and retracted medially;
- proximally the
radial nerve will be encountered in the spiral groove,
approximately 13-15 cm above the joint line;
- distally the incision continues over the lateral border of the ulna;
- preserve as much of the triceps insertion as possible (upto 3/4 of the insertion
can be sharply elevated off the ulna;;
- further exposure can be achieved by removing the most proximal portion of the
olecranon process (removing only the non articular portion of the olecranon);
- wound closure include proximal reattachment of the triceps insertion into
crossing drill holes into the olecranon, and more distally anchoring
the periosteum to the superficial forearm fascia;
