Table 1: Surgical Approaches Used for Treatment of Fractures of the Distal Humerus (Canale & Beaty: Campbell's Operative Orthopaedics, 11th edition, Mosby (2007)17.

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

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