A modified posterolateral approach to the elbow and proximal radioulnar joints.

A modified posterolateral approach is useful for extensive exposure of the elbow and proximal radioulnar joints. The patient is placed prone and the elbow flexed over a padded support: a pneumatic tourniquet is placed proximally on the arm. The laterally curved skin incision extends from the center of the posterior surface of the arm, at the upper limit of the triceps tendon, to the back of the lateral epicondyle and thence to the posterior border of the ulna 3 finger-breadths distal to the tip of the olecranon. The large medial and smaller lateral flaps are secured with sutures. The ulnar nerve is exposed and protected. A distally based tongue of triceps tendon is fashioned and retracted downwards. The anconeus is separated from the extensor carpi ulnaris muscle and retracted medially with the underlying capsule. The common extensor origin and the lateral collateral ligament, with the adjacent capsule, are partially reflected from the humerus. Excellent exposure of the elbow and proximal radioulnar joints is easily achieved and visualization can be increased by putting a varus strain on the elbow.