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.

• 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