Posteromedial Elbow Approach for Treatment of Olecranon and Coronoid Fractures

Abstract

This article illustrates the posteromedial elbow approach to address both coronoid and olecranon ulnar fractures. Olecranon and coronoid fractures were simulated in 6 cadaveric elbows. The osteotomies were made with a percutaneously placed osteotome through the olecranon fossa and the elbow joint. To expose these osteotomies, each elbow underwent a posterior midline skin incision, medial skin flap elevation, anterior transposition of the ulnar nerve, and subperiosteal elevation of the ulnar arm of the flexor carpi ulnaris. Fracture fixation was performed with posteriorly placed plates and screws. Each procedure was documented using radiographs and digital photography. The 6 procedures illustrated a surgical approach that is expedient in exposing the olecranon, medial elbow joint, and medial coronoid wall. All osteotomies were anatomically reduced and internally fixed in this setting. This technique allowed supine positioning of the cadaver and the use of an arm table for radiographic imaging in the lateral and anteroposterior planes. The direct visualization of both the coronoid and olecranon fracture facilitated anatomic reduction using standard surgical techniques. This technique also preserved the pronator attachment to the humerus, transposed the ulna nerve, and reapproximated the flexor carpi ulnaris fascia.