The first step in the exposure of the capitellum and the radial head, is an incision starting 5 cm proximal to the elbow joint, extending to the lateral surface of the proximal forearm.
In the medial approach, care must be taken not to compromise the ulnar nerve, or and the posterior branch of the medial cutaneous antebrachial nerve.
This approach involves an osteotomy of the olecranon in order to allow better access to the elbow joint.
Posterior triceps-on approach
For some extraarticular and simple articular fractures of the distal humerus, the posterior triceps-on approach, which leaves the triceps insertion intact, can provide adequate exposure for reduction and fixation.
The triceps elevating approach offers an extensile posterior exposure to the elbow, which allows for an effective restoration of the triceps function.
Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.