15

ANTEROLATERAL (INTERNERVOUS) APPROACH

USES

This approach is used primarily for plating the proximal radius. It is an alternative approach to the dorsolateral approaches. Campbell refers to this approach as the Henry approach and describes it as starting proximal to the elbow. The description here starts at the elbow.

ADVANTAGES

This is an internervous approach with everything on the lateral side being radial nerve innervated and everything on the medial side being median nerve innervated. It is also an approach that easily allows proximal and distal extension.

DISADVANTAGES

There are no major disadvantages to this approach except lack of surgeon familiarity with it.

STRUCTURES AT RISK

The major structure at risk is the radial nerve if you get lost too far to the lateral side. The key to finding the radial nerve is identifying the brachioradialis and looking underneath it. The posterior interosseous nerve will enter the supinator approximately 3 cm distal to the head of the radius. These muscles need to be identified, and the nerves can be easily avoided.

There is a vascular leash of one or more vessels of the radial recurrent artery, which crosses the incision. Plating on the most proximal portion of the radius, these blood vessels will almost certainly have to be ligated.

On the medial side, the median nerve and brachial artery are potentially at risk. They are medial to the biceps tendon, which is easily palpable. As long as you stay lateral to the tendon, the artery and nerve are safe.

TECHNIQUE

The incision starts at the lateral aspect of the elbow flexor crease, which places it approximately 2 cm proximal to the elbow joint itself. It is just to the medial side of the brachioradialis, which is usually palpable. The incision is carried through the subcutaneous tissue. The fibers of the brachioradialis are identified by their longitudinal orientation. They are gently retracted laterally until the radial nerve on the muscle’s undersurface is identified so it can be retracted. This retraction needs to be very gentle or you will damage the posterior interosseous nerve as it enters the supinator. Once that is done, the biceps tendon is exposed. This becomes the medial extent of your dissection. The interval between the biceps and the brachioradialis is developed and carried into the forearm. At the deeper level, you will be developing the interval between the pronator teres and the supinator.

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterior Approach Deltopectoral Approach Posterior Approach Anterior Approach to the Cervical Spine

Stay updated, free articles. Join our Telegram channel

Join