Surgical Approach | Indications | Contraindications | Advantages | Disadvantages |
---|---|---|---|---|
Olecranon osteotomy | Open reduction and internal fixation (ORIF) for fractures involving columns and articular surface | Total elbow replacement (TER) | Good access to posterior articular surfaces for reconstruction | Nonunion and failure of fixation of osteotomy Poor anterior access to capitellum |
Triceps-splitting | ORIF/TER for fractures involving columns and articular surface | Previous olecranon osteotomy approach Patients at increased risk for healing problems |
Avoids complications associated with olecranon osteotomy | Poor access to articular surface for internal fixation Risk of triceps detachment |
Triceps-reflecting | Fractures requiring TER | ORIF Previous olecranon osteotomy approach Patients at risk for healing problems |
Avoids complications associated with olecranon osteotomy | Risk of triceps detachment |
Triceps-detaching | ORIF/TER for fractures involving columns and articular surface | Previous olecranon osteotomy approach Patients at risk for healing problems |
Avoids complications associated with olecranon osteotomy | Poor access to articular surfaces for internal fixation Risk of triceps detachment |