The triceps anconeus pedicle (TRAP) approach involves reflecting the triceps and anconeus proximally, much like an olecranon osteotomy, by combining medial Bryan-Morrey and lateral modified Kocher approaches. It has a number of advantages and disadvantages. The main advantages of the TRAP approach are that it avoids hardware complications and olecranon nonunion and does not potentially contribute to post-traumatic arthritis or intra-articular adhesions. In addition, the TRAP approach permits total elbow arthroplasty and open reduction and internal fixation through the same exposure. This is especially important in very comminuted fractures in elderly patients, in which adequate reduction and fixation may not be possible. By retaining the entire olecranon intact, one can use the olecranon, coronoid, and radial head as a three-dimensional template against which to assemble the articular fragments until adequate provisional fixation is obtained.
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