Posterolateral approach to Radial Head

Indications

ORIF
Excision
Replacement

Position

Supine
Arm positioned over chest
Pronate forearm

Landmarks

Lateral humeral epicondyle
Radial head
- 2.5 cm distal to lateral epicondyle
Olecranon

Incision

5 cm Longitudinal incision
Start: Posterior surface of lateral humeral epicondyle
Continued downward & medially
End: towards the posterior border of ulnar

Internervous Plane

Anconeus Radial nerve
ECU PIN

Superficial Dissection

Deepen skin incision through fat & deep fascia
Identify the plan between Anconeus & ECU
Develop it with blunt dissection & detach part of the superior origin of Anconeus from the lateral humeral epicondyle

Deep Dissection

Fully Pronate forearm to protect the PIN
Incise capsule longitudinally
- Capitellum
- Radial head
- Annular ligament

Dangers

PIN

To expose capitellum
- Cut down onto lateral supracondylar ridge
- Elevate subperiosteally