Surgical Approaches to the Elbow in Fixation of Traumatic Injuries

Elbow fractures and fracture-instability injuries are increasingly prevalent. Gaining adequate exposure to the joint surface poses considerable challenges due to the unique articular anatomy and intricacies of the neurovascular structures traversing the elbow. Laterally, the radial head and capitellum are accessed through a classic Kocher or variations of the Kaplan technique. Posteriorly, the distal humerus is exposed by retracting the extensor mechanism through triceps split, reflection, or olecranon osteotomy. The medial approach may expose the coronoid through or around the flexor carpi ulnaris while protecting the ulnar nerve. The anterior elbow is approached by splitting brachioradialis and biceps, but extensile measures are limited. With increasing fracture complexity, posterior approaches are popular due to the access of medial and lateral columns of the distal humerus. Management of the triceps varies by surgeon preference and the need for articular exposure. More extensile techniques with lateral ulnar collateral ligament release provide near-total visualization of the articular surface. In addition, arthroscopic-assisted fracture fixation is an available adjuvant to provide minimally invasive access to the joint. Because of the complexity of elbow anatomy with limited global access, surgeons' familiarity with classic, extensile, and combined exposures is necessary to facilitate surgical reconstruction.