Pol Rommens, Peter Trafton, Martin Jaeger. Join from wherever you are in the world. Each approach has its advantages and disadvantages. Mills WJ(1), Hanel DP, Smith DG. The complete incision is illustrated here. Campbell and Hoppenfeld describe this approach as the anterolateral approach to the humerus, and both describe splitting the brachialis muscle. Campbell and Hoppenfeld describe this approach as the anterolateral approach to the humerus, and both describe splitting the brachialis muscle. Irrigate the wound. The radial nerve enters the anterior compartment by perforating the lateral intermuscular septum. between the brachialis (musculocutaneous n. and radial n.) and brachioradialis (radial n.) make a curved incision over the lateral border of the biceps centered over the fracture site. Proximally, look for the cephalic vein in the deltopectoral interval. A split can be performed most easi- ly through either raphe. It can be extended proximally also to expose the proximal humerus. Mobilize the radial nerve, as needed, to access the bone. Copyright © 2020 Lineage Medical, Inc. All rights reserved. The incision follows a line extending from the interval distally between biceps and the mobile wad (brachioradialis and the wrist extensors) to the deltopectoral interval proximally, following the lateral edge of biceps and the anterior edge of the deltoid. The anteri- or raphe allows better access to the supraspinatus insertion and is opti- mal for antegrade humeral nailing. Mobilize the radial nerve, as needed, to access the bone. Indications for operative treatment of fractures of the shaft of the humerus … We present an alternative, “lateral” approach to the humeral shaft. The lateral approach allows safe exposure of the distal two thirds of the humerus. This approach allows supine positioning of the multiply injured patient and visualization of the radial nerve throughout the extent of the incision, and requires no muscle splitting. But splitting the brachialis muscle risks denervating the lateral half of … 2. identify the lateral border of the biceps muscle and retract medially. The use of Hohmann retractors in the distal 2/5 of the humerus carries a high risk of iatrogenic nerve injury and should therefore be avoided. Alternatively, the brachialis may be retracted medially. Author information: (1)Department of Orthopedic Surgery, University of Washington, Seattle, USA. Beware that this injures the radial nerve branch to the brachialis. 1. Introduction: Although most humeral shaft fractures can be treated nonoperatively, many patients do benefit significantly from surgical treatment. Alternatively dissect bluntly under the central deltoid insertion to allow for plate placement. supine w/ arm flexed 90 deg and laid over the pt abdomen want to exsanguinate the arm. Distally, the anterior humerus has been exposed to the elbow joint, between the mobile wad and brachialis. ORIF of the lateral condyle Surgical treatment of tennis elbow. This approach is internervous because the anterior musculature of the biceps and brachialis is innervated by the musculocutaneous nerve and the triceps is innervated by the radial nerve. Follow the nerve to the point where it passes through the lateral intermuscular septum. Follow the nerve to the point where it passes through the lateral intermuscular septum. Open reduction and internal fixation of distal humerus fractures (lateral condyle) Open treatment of lateral epicondylitis : Anatomic Plans : Internervous plane (none) Between the triceps (radial n.) and brachioradialis (radial n.) Positioning : Anesthesia; Position. What is the lateral approach to the distal humerus used for? Close the subcutaneous tissues and the skin in layers in a standard manner. supine with arm lying across chest; Turniquet Approach: Incision If it is retracted with the deltoid, muscular tributaries are less likely to be torn. Minimize any detachment of subcutaneous tissue from the muscular fascia. Anterolateral Approach to Distal Humerus. However, it can also be taken in the supine position in the acute, trauma setting. If necessary release some of the muscle attachment proximally to allow the plate to lie on the bone. Depending on the fracture and its location, a smaller section might be used. We present an alternative, "lateral" approach to the humeral shaft. Placement of a drain underneath the deltoid muscle might be considered. make a curved or straight incision over the lateral supracondylar ridge, incise the deep fascia in line with the skin incision, identify the plane between the brachioradialis and triceps, Cut in between these two muscles down to bone, Reflect the triceps posteriorly and the brachioradialis anteriorly, rhe common extensor origin can be released off the lateral humerus and the triceps can be similarly elevated posteriorly, proximal extension cannot be obtained due to the radial nerve crossing proximally in line with the incision, distal extension can be obtained by extending into the interval between the anconeus (radial n.) and extensor carpi ulnaris (posterior interosseous n), this extension can only be carried to the radial head to avoid potential injury to the posterior interosseous nerve, This nerve is at risk with proximal extension, as the nerve pierces the lateral septum in the distal third of the arm, Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Direct Lateral Approach (Hardinge, Transgluteal), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine, Open reduction and internal fixation of distal humerus fractures (lateral condyle).

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