Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.
A straight midline incision provides direct subcutaneous access to the proximal olecranon. Skin and subcutaneous flaps can be developed to access both medial and lateral approaches described below. Laterally, the midline incision can be developed submuscularly as the Boyd approach, gaining exposure for ulnar shaft and radial head fractures.
The lateral Kocher/Kaplan approach can be used to access the radial head and the tip of the coronoid.
The anterior approach can be used to access the bicipital tuberosity of the radius and/or the radial neck/metaphysis.
The Hotchkiss “over the top” approach is the most anterior of the medial approaches and provides good access to the tip of the coronoid process and the whole anterior elbow joint.
The Taylor and Scham approach is a good choice for medial plate fixation of large, basilar fractures of the coronoid.
In contrast to the Hotchkiss approach, the FCU split provides a better access to the anteromedial facet of the coronoid, the sublime tubercle, and the medial collateral ligament.