Aim
We describe a novel triceps exposure approach for TEA, the anconeus-triceps lateral flap, which has proved valuable in patients with distal humeral and olecranon fractures malunion, and its preliminary results at a minimum follow-up of 24 months.
Background
Over the past decade, total elbow arthroplasty (TEA) procedures have increased due to an increase in the number of trauma patients. Most current posterior approaches to the elbow provide excellent joint exposure, but involve the risk of extensor mechanism injury and eventual insufficiency, particularly in patients with osteoarthritis (OA) secondary to fracture.
Methods
Twenty consecutive patients with OA due to distal humeral and olecranon fractures malunion underwent TEA by the anconeus-triceps lateral flap approach, which preserves the olecranon insertion of the medial portion of the triceps proper tendon.
Results
At a mean follow-up of 33 months, the mean Mayo Elbow Performance Score rose from 41.3 to 94.3. The mean score of the visual analog scale for pain fell from 7.1 to 1.1. There were no patients with insufficiency or secondary detachment of the triceps tendon reporting grade 4 to 5 of the Medical Research Council scale.
Discussion
These preliminary data suggest that preservation of the insertion of the medial portion of the triceps proper tendon enables earlier active rehabilitation. Moreover, the new approach provides optimum exposure of the olecranon also in patients with OA secondary to intra-articular fracture of the distal humerus and olecranon, where scarring and bone deformity usually hamper joint exposure.
Conclusion
The present preliminary data suggest that preservation of the medial portion of the triceps tendon insertion in patients undergoing TEA for OA secondary to fracture: i) reduces the risk of triceps insufficiency and enables early active rehabilitation; ii) affords optimum surgical exposure of the olecranon articular surface, especially in elbows with severe fracture malunion, like the patients described here; iii) and allows adequate alignment of the olecranon and the posterior ulnar surface without the interposition of the entire triceps muscle-tendon unit between the planes, since the relationship between them is a key landmark for ulnar component positioning.