The Anconeus-Triceps Lateral Flap Approach: New Surgical Exposure for Total Elbow Arthroplasty

Over the past 2 decades, the indications for total elbow arthroplasty have increased for acute and chronic pathologies. One complication following total elbow arthroplasty that is well recognized but is poorly described in the literature is the insufficiency of the extensor mechanism. During the last 3 years we have been using a modified triceps approach for total elbow arthroplasty using the anconeus-triceps lateral flap approach. This new approach preserves the proper triceps tendon medial insertion, and the lateral triceps, maintaining the continuity with the anconeus muscle as a flap single unit, is released and reflected proximally. This links the advantage of the triceps-preserving exposure (preserving the proper medial triceps tendon insertion) with the advantages of the triceps-splitting or triceps-reflecting exposures (better surgical exposure of the olecranon surface). It can be performed with the linked and unlinked total elbow prosthesis or with distal humeral hemiarthroplasty commercially available. Patients are able to perform light functional activity immediately postoperatively because the medial proper triceps insertion is preserved. The aims of this study are to describe the anatomic aspects of the triceps tendon insertion and to describe the surgical steps of the anconeus-triceps lateral flap approach used in total elbow arthroplasty.

Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Techniques Source Type: research