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Fig. 1
Diagram of the posterior view of the elbow show-
ing the incision through the triceps and the line of
incision to decompress the ulnar nerve.
Fig. 2
Fig. 3
operative neurapraxia of the ulnar nerve. Spontaneous cause was traction or pressure on the nerve during the
recovery occurred in this patient after eight weeks. Dehis- operation.
cence of the triceps was seen on one occasion in a patient Our technique allows the raising of the major part of the
who had undergone several previous surgical procedures triceps in continuity. Protection of the ulnar nerve by the
through posterior approaches after an infected comminuted medial part of triceps reduces the possibility of damage to
distal fracture of the humerus. its blood supply and at the end of the operation it can glide
and slide in its original position. The availability of the two
Discussion segments of the triceps muscle for the repair allows sat-
isfactory balancing of the medial and lateral sides of the
5
Campbell described the posterior split of the triceps mus- elbow, reducing the risk of postoperative dislocation.
cle in the midline, and continued the exposure distally in No benefits in any form have been received or will be received from a
the forearm by elevating the anconeus and flexor carpi commercial party related directly or indirectly to the subject of this
3 article.
ulnaris. Steiger et al modified this approach by raising
6
osteoperiosteal flaps from the olecranon. Van Gorder cre- References
ated an inverted ‘V’-shaped flap of the triceps mechanism 1. MacAusland WR. Ankylosis of the elbow, with report of four cases
to expose the distal humerus. In all of these approaches treated by arthroplasty. J Am Med Assoc 1915;64:312-8.
there is considerable mobilisation of the ulnar nerve. Petal- 2. Morrey BF, Bryan RS, Dobbyns JH, Linscheid RL. Total elbow
arthroplasty: a five-year experience at the Mayo clinic. J Bone Joint
ling of the olecranon, described in the Gschwend approach, Surg [Am] 1981;63-A:1050-63.
can be difficult to achieve safely in patients with rheuma- 3. Steiger JU, Gschwend N, Bell S. GSB elbow arthroplasty: a new
toid arthritis who have marked bony erosion of the ulna. concept and six years’ experience. In: Kashiwagi D, ed. Elbow joint.
9 Amsterdam: Elsevier Science Publishers BV (Biomedical Division),
The technique, described by Boyd, involves reflecting the 1985:285-94.
entire triceps mechanism from the lateral to the medial side. 4. Wolfe SW, Ranawat CS. The osteoanconeus flap: an approach for
7 total elbow arthroplasty. J Bone Joint Surg [Am] 1990;72-A:684-8.
Bryan and Morrey used a similar technique but with
5. Campbell WC. Incision for exposure of the elbow joint. Am J Surg
reflection of the triceps from medial to lateral, beginning at 1932;15:65-7.
the medial intermuscular septum. The triceps was reflected 6. Van Gorder GW. Surgical approach in supracondylar ‘T’ fractures of
in continuity with the fascia of the forearm and the peri- the humerus requiring open reduction. J Bone Joint Surg 1940;22:
278-92.
osteum. The advantage of this approach is that the muscle
7. Bryan RS, Morrey BF. Extensive posterior exposure of the elbow
is neither split nor violated and continuity of the extensor joint: a triceps sparing approach. Clin Orthop 1982;166:188-92.
mechanism is maintained with the forearm fascio-ulnar- 8. Muller ME, Allgower M, Willenegger H. Manual of internal fixa-
periosteal complex. Ten out of 80 total elbow arthroplasties tion: technique recommended by the AO group. New York: Springer-
2 Verlag, 1970.
carried out by Morrey et al had ulnar neuropathies, eight 9. Boyd HB. Surgical exposure of the ulna and proximal third of the
temporary and two permanent. They presumed that the radius through one incision. Surg Gynecol Obstet 1940;71:86-8.