Anterior Approach to Humerus Shaft

Anterior Approach to Humerus Shaft is used to treat the following conditions:

  1. Open reduction and internal fixation of humerus shaft fractures.
  2. Humeral tumor biopsy/resection.
  3. Humeral osteotomy.
  4. Treatment of osteomyelitis.

  • Supine position with the arm on arm board, abducted 60 degrees

  • Landmarks:
    1. The Coracoid process.
    2. The long head of the biceps brachii.
  • Incision:
    1. Make a curved incision from the tip of the coracoid process distally in line with deltopectoral groove along the lateral aspect of the humerus.
    2. 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
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