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Humeral Shaft Approaches

Anterolateral Approach

Anterolateral Approach

  • Adequate for: proximal 1/3, midshaft fx,distal 1/3 fx,
  • Postion: supine or modified beach chair
  • Incision: longitudinal just lateral to biceps.
  • Proximal exposure between deltoid and pec major insertions.
  • Distal exposure splits brachialis origin off humerus with medial retraction of biceps muscle.
  • Extension: can be extended into deltopectoral approach to the proximal humerus.
  • Risks: Radial nerve, lateral antebrachial cutaneous nerve, cephalic vein.
  1. Cephalic vein
  2. Lateral antebrachial cutaneous nerve
  3. Radial nerve
  4. Brachialis origin

 

 

Posterior Approach

Posterior Approach

  • Adequate for: midshaft fx,distal 1/3 fx, radial nerve palsy
  1. Lateral Brachial cutaneous nerve
  2. Radial nerve
  3. Profunda brachii artery
  4. Triceps - medial (deep) head
  5. Ulnar nerve
Anteromedial Approach

Anteromedial Approach

  • Rarely used
  • Anteromedial incision proximal to medial epicondyle
  • Dissection posterior to intermuscular septum
  • Ulnar nerve freed from triceps and reflected medially.
  • Median nerve and brachial artery reflected laterally.
  • Risks: Ulnar nerve, median nerve, brachial artery.
  1. Ulnar nerve
  2. Brachial artery and veins
  3. Median nerve
  4. Cephalic vein