Anterolateral approach to the distal humerus

Aims

Brachialis / BR

Indications

distal 4th of humerus
- ORIF
- Exploration of radial nerve

Position

supine
arm board

Landmarks

biceps
anterior flexion crease of elbow

Incision

curved longitudinal incision along lateral border of biceps
Start: 10 cm above elbow crease
End: just above elbow crease

Internervous Plane

Brachialis
- radial nerve
Brachioradialis
- Radial nerve

Superficial Dissection

Beware lateral cutaneous nerve of forearm
Identify lateral border of biceps & retract medially
Develop the plane between brachialis & brachioradialis
Identify the radial nerve near the elbow & follow it up to where it pierces the lateral intermuscular septum
Isolate & retract radial nerve laterally with vascular loops

Deep Dissection

Incise along the lateral border of brachialis down to periosteum & bone

Dangers

Nerves
- lateral cutaneous nerve of forearm
- radial nerve