Lateral Approach to Distal Humerus

The lateral approach to distal humerus exposes the lateral epicondyle and the origin of the wrist extensors.

  • Its uses include the following:
    1. Open reduction and internal fixation of fractures of the lateral condyle.
    2. Surgical treatment of tennis elbow (lateral epicondylitis)
    .

  • Supine with arm lying across chest

  • Landmarks:
    1. Lateral epicondyle.
    2. The lateral supracondylar ridge of the humerus .
  • Incision:
    • Make a 4- to 6-cm curved or straight incision on the lateral aspect of the elbow over the lateral supracondylar ridge.

  • There is No Internervous plane for Lateral Approach to Distal Humerus.
  • The dissection is carried out between the triceps muscle (radial nerve) and brachioradialis muscle (radial nerve).

  • Incise the deep fascia in line with the skin incision.
  • Identify the plane between the brachioradialis and triceps muscles,
    • Cut in between these two muscles down to bone.
    • Reflect the triceps muscle posteriorly and the brachioradialis muscle anteriorly.

  • The common extensor origin can be released off the lateral humerus and the triceps can be similarly elevated posteriorly.

  • Proximal Extension:
    • Proximal extension is not possible, because the radial nerve crosses the proposed line of dissection.
  • Distal Extension:
    • The lateral approach can be extended to the radial head only by using the intramuscular plane between the anconeus muscle (which is supplied by the radial nerve) and the extensor carpi ulnaris muscle (which is supplied by the posterior interosseous nerve).

  • The radial nerve is at risk with proximal extension of the lateral approach to distal humerus, as the nerve pierces the lateral septum in the distal third of the arm.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Lateral Approach to the Distal Humerus Lateral Approach to the Distal Humerus Lateral Approach to the Distal Humerus Lateral Approach to the Distal Humerus Lateral Approach to the Distal Humerus
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