A posterior approach to the elbow joint based on the blood supply to the triceps muscle

  • Aysha Sethunathan RajeevEmail author
  • J. Pooley
Original Article


We describe a posterior approach to the elbow joint based on anatomical studies of the blood supply to the triceps muscle, and observation of the musculotendinous insertion of triceps. These studies demonstrated that the triceps muscle is essentially supplied by end arteries. Any distal-proximal anastamoses from the collateral branches of the radial and ulnar arteries, occur at the small vessel level. The insertion of triceps is musculotendinous with an aponeurosis consisting of two laminae, one superficial and one deep, as well as direct muscle insertion into the olecranon. Our approach provides an excellent exposure of the distal humerus without the division of any fibers of triceps preventing any muscle necrosis and scarring. We formally dissect the two laminae of the triceps aponeurosis, and divide the deeper intramuscular aponeurosis 2 cm proximal to the olecranon. At closure, correct tensioning of the intramuscular aponeurosis allows for soft tissue balancing and optimum elbow function. We use this approach for total elbow replacement, open reduction and internal fixation of distal humerus fractures and in the open reduction of displaced supracondylar fractures in children. We have had no cases of a triceps tendon dehiscence in over 400 cases.


Triceps preserving Vascular studies Anatomical safe Reproducible 



No funds were received in support of this study.

Conflict of interest statement

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Queen Elizabeth HospitalGatesheadUK
  2. 2.WashingtonUK
  3. 3.Department of OrthopaedicsQueen Elizabeth HospitalGatesheadUK

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