title: A new posterior triceps approach for total elbow arthroplasty in patients with osteoarthritis secondary to fracture: preliminary clinical experience.
abstract: BACKGROUND
  During the past decade, total elbow arthroplasty (TEA) procedures have increased because of an increase in the number of trauma patients. Even though most current posterior approaches to the elbow provide excellent joint exposure, they involve the risk of extensor mechanism injury and of eventual insufficiency, particularly in patients with osteoarthritis (OA) secondary to fracture. I describe a new triceps exposure approach for TEA, the anconeus-triceps lateral flap, which has proved valuable in patients with distal humeral and olecranon fracture malunion, and its preliminary results at a minimum follow-up of 24 months.
  
  
  METHODS
  Twenty consecutive patients with OA due to distal humeral and olecranon fracture 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 pain score on the visual analog scale fell from 7.1 to 1.1. There were no patients with insufficiency, secondary detachment of the triceps tendon, or grade 4 to 5 of the Medical Research Council scale.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy. Electronic address: celli.andrea1970@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Celli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods*; D005260:Female; D017759:Fractures, Malunited / Q000150:complications* / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000601:surgery; D057072:Intra-Articular Fractures / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D010003:Osteoarthritis / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014458:Ulna Fractures / Q000150:complications / Q000601:surgery
keywords: Elbow; anconeus–triceps lateral flap; articular malunion; elbow replacement; medial triceps tendon proper; triceps exposure