8

LATERAL APPROACH TO THE HUMERUS

USES

This approach is used primarily for fracture work.

ADVANTAGES

This approach is internervous because the anterior musculature of the biceps and brachialis is innervated by the musculocutaneous nerve and the triceps is innervated by the radial nerve. Campbell and Hoppenfeld describe this approach as the anterolateral approach to the humerus, and both describe splitting the brachialis muscle. But splitting the brachialis muscle risks denervating the lateral half of the muscle by cutting the small nerves crossing laterally.

DISADVANTAGES

For fractures of the midshaft, this is an excellent approach. However, if the fracture line extends distally, then this approach provides poor visualization to the posterior aspect of the humerus where internal fixation will frequently need to be placed.

STRUCTURES AT RISK

The major structure at risk with this approach is the radial nerve, which crosses from posterior to anterior in the region of the junction of the middle and distal thirds. This nerve must be identified in all plating of the humerus and protected. The key landmark for finding the radial nerve is the fibers of the brachioradialis. Since these fibers come in perpendicular to the shaft of the humerus, they can generally be fairly easily differentiated from the fibers of the biceps or triceps. The nerve crosses around the lateral aspect of the humerus just proximal to the muscle origin.

TECHNIQUE

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Anterior Approach to the Distal Thigh and Femur Anterolateral Approach to the Tibia Deltopectoral Approach Posterior Approach Anterior Approach to the Cervical Spine

Stay updated, free articles. Join our Telegram channel

Join