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Surgical Approaches to the Elbow

Dr. Cheung is Assistant Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA. Dr. Steinmann is Professor, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.

Dr. Steinmann or a member of his immediate family serves as a paid consultant to or is an employee of Arthrex and DePuy, has received research or institutional support from Wright Medical Technology, and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from the publishers of the Yearbook of Hand Surgery. Neither Dr. Cheung nor a member of her immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Cheung, Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063.

Surgical exposures for complex injuries about the elbow are technically demanding because of the high density of neurologic, vascular, and ligamentous elements around the elbow. The posterior approaches (ie, olecranon osteotomy, triceps-reflecting, triceps-splitting, triceps-reflecting anconeus pedicle flap, paratricipital) include techniques used to navigate the area around the triceps tendon and anconeus muscle. These approaches may be extended to gain access to the entire joint. The ulnar nerve, the anterior and posterior capsules, and the coronoid process are addressed by means of a medial approach. Lateral approaches are useful in addressing pathology at the radial head, capitellum, coronoid process, and anterior and posterior capsules. These approaches may be combined to address complex pathology in the setting of fracture fixation, arthroplasty, and capsular release.