Versatility Through the Boyd Approach

Abstract

Complex elbow fractures are among the most difficult to treat due to the multiple articulations requiring reduction and the density of neurovascular structures limiting exposure. Frequently multiple approaches are required to access all bones involved without sacrificing important surrounding structures. Some of the most complex injuries include fractures of the olecranon, radial head, and coronoid from fracture/disruptions of the elbow. In these instances, the ulnohumeral, radiocapitellar, and proximal radioulnar joints are all disrupted and require visualization for appropriate treatment. Boyd first described a single-incision approach that allowed access to all these joints safely in 1940. This is a very versatile approach for treating elbow trauma that otherwise would require multiple incisions. With appropriate technique, the surrounding neurovasculature can also be preserved. The Boyd approach, however, fell out of favor given reports of synostosis. We find the exposure granted by this approach ideal for treating these complex injuries and have not seen synostosis in any cases.