TRICEPS REFLECTING

ANCONEUS PEDICLE
APPROACH(TRAP)

Dr Vipin
Applied anatomy
 Posterior structures
• skin
• s/c tissue
• triceps with aponeurosis
• ulnar nerve
• posterior capsule
 Why posterior approach?
• Safer : less chance of damage to vital
structures

• Easier : posterior structures are

aponeurotic and dissection easier with
less bleeding

• Clearer : better visualization of the

articular surface
Posterior approach

1 2 3 4
Triceps Triceps Triceps
Osteotomy
splitting reflecting preserving
approach
approach approach approach
Triceps reflecting approach

1 2
BRYAN
TRAP by
MOORE
O’Driscoll
APPROACH
 TRAP
• Tricps Reflecting Anconeus Pedicle
approach
Patient positioning
 common steps
• longitudinal midline
skin incision over
posterior aspect of
elbow
• raising subcutaneous
flaps
Isolation of ulnar nerve

• identify proximally
• release the tunnel by
dividing the fascia
• retract it with a rubber
sling
• extensive dissection
is not advised
TRAP STEPS
• begins laterally at
kocher interval
TRAP incorporates
• modified kocher’s
approach laterally

• triceps reflecting
approach on medially

• converge distally at
the tip of anconeus
integrity of LCL and annular ligament
preserved
proceed with fracture fixation
• triceps reattached with interrupted sutures
with use of drill holes through bone in the
region of olecranon
 advantages
• avoid olecranon osteotomy and related
complication
 risks
• risk of triceps dehiscence and detachment
• possible extensor weakness
• THANK YOU