O'Driscoll describes the TRAP approach — a posterior elbow exposure combining a modified Kocher approach laterally with the Bryan-Morrey triceps-reflecting approach medially — as an alternative to olecranon osteotomy for surgical treatment of complex distal humeral fractures and nonunions. The paper details surgical technique and argues for this approach based on anatomic, functional, and strategic advantages over osteotomy.
When approaching a complex intra-articular distal humerus fracture posteriorly, consider TRAP over olecranon osteotomy if you need to preserve the intact olecranon as a reduction template or anticipate converting to total elbow arthroplasty — but default to osteotomy if your volume is low, since TRAP's slightly restricted articular view requires comfort with the anatomy to avoid undertreating comminution.
O'Driscoll describes the TRAP approach — a posterior elbow exposure combining a modified Kocher approach laterally with the Bryan-Morrey triceps-reflecting approach medially — as an alternative to olecranon osteotomy for surgical treatment of complex distal humeral fractures and nonunions. The paper details surgical technique and argues for this approach based on anatomic, functional, and strategic advantages over osteotomy.
When approaching a complex intra-articular distal humerus fracture posteriorly, consider TRAP over olecranon osteotomy if you need to preserve the intact olecranon as a reduction template or anticipate converting to total elbow arthroplasty — but default to osteotomy if your volume is low, since TRAP's slightly restricted articular view requires comfort with the anatomy to avoid undertreating comminution.