Updated: 9/24/2014

Lateral Approach to Distal Humerus

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Introduction
  • Indications
    • Open reduction and internal fixation of distal humerus fractures (lateral condyle)
    • Open treatment of lateral epicondylitis
 

Anatomic Plans  
  • Internervous plane (none)
    • Between the triceps (radial n.) and brachioradialis (radial n.)
 
Positioning  
  • Anesthesia
  • Position
    • supine with arm lying across chest
  • Turniquet
 
Approach
  • Incision 
    • make a curved or straight incision over the lateral supracondylar ridge

  • Superficial dissection
    • incise the deep fascia in line with the skin incision
    • identify the plane between the brachioradialis and triceps
      • Cut in between these two muscles down to bone
      • Reflect the triceps posteriorly and the brachioradialis anteriorly
  • Deep dissection
    • rhe common extensor origin can be released off the lateral humerus and the triceps can be similarly elevated posteriorly
  • Extension
    • proximal extension cannot be obtained due to the radial nerve crossing proximally in line with the incision
    • distal extension can be obtained by extending into the interval between the anconeus (radial n.) and extensor carpi ulnaris (posterior interosseous n)
      • this extension can only be carried to the radial head to avoid potential injury to the posterior interosseous nerve
 


Dangers
  • Radial nerve
    • This nerve is at risk with proximal extension, as the nerve pierces the lateral septum in the distal third of the arm
 
 

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