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POSTERIOR APPROACH TO THE DISTAL HUMERUS

USES

This approach is used primarily for fracture work in the distal humerus. It is occasionally used for radial nerve explorations.

ADVANTAGES

If you are distal to where the radial nerve comes behind the humerus, this is a safe approach in an area that is devoid of nerves or arteries. It provides the best visualization of the distal humerus. There is a saying that the front door to the elbow is in the back. It is the preferred approach for supracondylar and intracondylar fractures of the distal humerus. Campbell calls this the posterior lateral approach to the elbow.

DISADVANTAGES

The upper end of the approach can place the radial nerve at risk. It also provides no access to the anterior aspect of the humerus or elbow. At its most distal extent, the ulnar nerve can also be damaged as it passes behind the medial epicondyle.

STRUCTURES AT RISK

The radial nerve is the major structure at risk with this approach. It typically crosses the back of the humerus several centimeters proximal to the brachioradialis origin. Once the nerve is lateral to the humerus, it will then go underneath the brachioradialis and enter the forearm protected by that muscle. If the dissection is carried proximal to the junction of the middle and distal thirds, then the radial nerve is at risk and the dissection needs to be done very carefully as you go proximally.

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

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