Anterior Approach to Humerus Shaft
Anterior Approach to Humerus Shaft is used to treat the following conditions:
- Open reduction and internal fixation of humerus shaft fractures.
- Humeral tumor biopsy/resection.
- Humeral osteotomy.
- Treatment of osteomyelitis.
- Supine position with the arm on arm board, abducted 60 degrees
- Landmarks:
- The Coracoid process.
- The long head of the biceps brachii.
- Incision:
- Make a curved incision from the tip of the coracoid process distally in line with deltopectoral groove along the lateral aspect of the humerus.
- Incision should end approximately 5 cm short of elbow flexion crease (lateral antebrachial cutaneous nerve is at risk here).
- Proximally the Internervous plane in Anterior Approach to Humerus Shaft lies between:
-
- Deltoid muscle (axillary nerve),
- Pectoralis major muscle (medial and lateral pectoral nerves).
- Distally the Internervous plane in Anterior Approach to Humerus Shaft lies between:
- Medial brachialis muscle (musculocutaneous nerve),
- Lateral brachialis muscle (radial nerve).
- Identify the cephalic vein – can be taken medially or laterally.
- Proximally, develop the interval between the deltoid and pectoralis major muscle.
- Distally, incise the deep fascia of the arm in line with the skin incision.
- Identify the interval between the biceps muscle and brachialis muscle:
- Biceps muscle can be retracted medially or laterally (typically it’s taken medially).
- Proximally, incise the periosteum lateral to the pectoralis major tendon insertion, staying lateral to the long head of the biceps tendon:
- The anterior humeral circumflex artery is seen here and must be ligated.
- Distally, the fibers of the brachialis are split longitudinally along the midline to expose the periosteum and humeral shaft.
- Proximal Extension:
- Because the anterior approach uses the deltopectoral interval, its upper end can be modified easily into an anterior approach to the shoulder.
- Distal Extension:
- The anterior approach cannot be extended distally.
Structures at risk during anterior approach to humerus include:
- Anterior circumflex humeral artery:
- At risk proximally between the pectoralis major and deltoid muscle.
- Axillary nerve:
- Can be injured with vigorous retraction of the deltoid.
- Radial nerve:
- must be identified before any incision is made into the brachialis muscle or before periosteal elevation of the brachialis off the humerus occurs.
- also at risk on the middle 1/3 of the humerus where it lays in the spiral groove on the posterior humerus.
- Surgical Exposures in Orthopaedics book - 4th Edition
- Campbel's Operative Orthopaedics book 12th
Images Source:
- Surgical Exposures in Orthopaedics 4th Edition Book.
- Orthobullets Website
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