Posterolateral Approach

POSTEROLATERAL APPROACH

USES

This approach is the lateral equivalent of the approach to the ulnar nerve. The incision stays behind the lateral epicondyle and thus is useful for fractures of the capitellum and for open reductions and internal fixation of the distal humerus and the radial head. The exposure is useful for lateral ligament repairs around the elbow and for contracture releases around the elbow. This approach is a combination of Hoppenfeld’s lateral approach to the distal humerus and the posterolateral approach to the radial head. Campbell calls it the lateral and lateral J approach.

ADVANTAGES

This approach gives a good view of the lateral elbow and capitellum area. Also, by staying somewhat posterior, the radial nerve is less at risk.

DISADVANTAGES

It is difficult to visualize the posterior aspect of the humerus for comminuted fractures through this approach. The approach, therefore, is limited to either fractures of the capitellum or two-part supracondylar fractures. The approach is difficult to extend proximally or distally because of the radial nerve.

STRUCTURES AT RISK

The major structure at risk is the radial nerve. The radial nerve wraps around the humerus, and at the junction of the middle and distal thirds of the humerus the nerve is usually posterior. From there, it comes along the lateral border to enter the forearm anteriorly. The radial nerve can be transected if the brachioradialis is stripped off of its humeral origin because the nerve will have to come around the humerus right along the proximal edge of this muscle.

The blood supply to the capitellar fragment can be destroyed if all the soft tissue attaching to that lateral piece is removed. The blood supply to the capitellum is quite precarious and, especially in children, the soft tissue attachments need to be handled gently.

TECHNIQUE

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