Case: A 60-year-old woman sustained a type IV capitellum fracture from falling on an outstretched arm. Open reduction internal fixation (ORIF) was performed using an anconeus approach, and a transolecranon tunnel was created to place a trochlear screw. The patient showed good clinical outcomes with almost full range of motion at 6 months.
Conclusion: With type IV capitellum fractures, the olecranon often obstructs the screw trajectory necessary for anterior-to-posterior fixation of trochlear fragments. Drilling a transolecranon tunnel through the proximal olecranon with the elbow flexed creates a viable pathway for screw placement from a more medial starting point than what is possible with traditional techniques.
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