Anterolateral approach (Henry’s) to the Elbow

Indications

Exposure of lateral half of elbow joint
- Capitellum
- Proximal third of anterior aspect of radius
ORIF
- Capitellum
- Radial head fractures
- Biceps avulsion
Drainage
- Septic arthritis
Decompression
- Arcade of Frohse
- PIN
Total elbow replacements

Position

Supine
Arm board

Landmarks

Brachioradialis (mobile wad)
Biceps tendon
Anterior elbow crease

Incision

15 cm Curved longitudinal gentle S shaped incision along anterior aspect of elbow
Start: 5cm above elbow crease over lateral border of biceps
Cross elbow crease obliquely
End: Medial border of brachioradialis

Internervous Plane

Proximally
- Brachialis
  - Musculocutaneous nerve
- Brachioradialis
  - Radial nerve
Distally
- Brachioradialis
  - Radial nerve
- Pronator teres
  - Median nerve

Superficial Dissection

Identify & protect lateral cutaneous nerve of forearm
- Becomes superficial in distal 5 cm of arm
- Lateral to biceps tendon
- Between biceps & brachialis
Incise fascia on medial side of BR
Develop interval between BR & brachialis using blunt dissection
Identify & protect radial nerve at elbow
- which lives between BR & Brachialis
- follow it distally till its 3 branches
  - PIN
  - Superficial radial nerve
  - Branch to ECRB
Below division of nerve
- Develop plane between BR & PT
Ligate recurrent branches of radial artery
Retract Radial Artery Laterally

Deep Dissection

Incise anterior capsule between
- Laterally Radial Nerve
- Medially Brachialis
Fully supinate the forearm to expose insertion of supinator
Incise origin of supinator staying lateral to insertion of biceps

Dangers

Nerves
- Radial
- PIN
- Lateral cutaneous nerve of forearm
Vessels
- Radial artery
- Recurrent branches of radial artery