Exposure of the distal humerus using a triceps hemi-peel approach

This study evaluates the exposure of the distal humerus articular surface obtained using a triceps hemi-peel approach versus the triceps-flexor carpi ulnaris (TRIFCU) approach. Twelve cadaveric upper extremity specimens were dissected using a lateral-to-medial hemipeel modification of the TRIFCU approach to the elbow. After completing the hemi-peel exposure, the visible border of the articular surface was marked with a permanent ink pen. The dissection was continued to complete a standard TRIFCU approach, and the visible border of the exposure was again marked. The elbow was disarticulated, and calibrated digital images were taken to quantify the humeral surface area exposed through each approach. During both approaches, the surgeon's ability to visualize the intertrochlear groove, medial crista anterior crest, medial crista posterior crest, anterior capitulum, and posterior capitulum was recorded. No difference was found in the surgeons' ability to identify the 5 designated anatomic landmarks using the hemi-peel versus the TRIFCU approach. The TRIFCU exposed an average of 6.68 cm² of the trochlear articular surface, whereas the hemi-peel approach exposed an average of 5.93 cm². The average difference between the exposures was 0.75 cm² (P<.001), or 12.5%. The hemi-peel and TRIFCU approaches to the elbow both allow excellent visualization of the distal humerus articular surface. The hemi-peel exposure is a useful approach for the accurate reduction and fixation of displaced intra-articular distal humerus fractures.