Transhumeral amputation is ideally performed about 4 cm above the elbow joint, leaving room for a prosthetic elbow lock. Muscle myodesis stabilises the residual limb, and targeted muscle reinnervation can reduce neuroma pain and improve myoelectric prosthetic control.
General Principles
Ideally 4cm proximal to elbow joint
- This amount of length allows for an elbow lock mechanism prostheses to be fit
- This stabilises the joint in any position from full extension to full flexion to allow for better function
At or above pec major leads to no rotation
- Becomes essentially a shoulder disarticulation
- Maintains humeral head though which maintains shoulder contour — more cosmetically pleasing
Technique Considerations
Supracondylar Area
- Equal anterior & posterior flaps each of length that is half the diameter of arm at that level
- Doubly ligate & divide brachial artery just proximal to level
- Transect median/ulnar/radial nerves higher so ends retract well proximal to end of stump
- Divide anterior muscles approx 1.3cm distal to level so retract to level
- Free triceps from olecranon preserving it as a long flap
- Incise periosteum circumferentially at least 4cm proximal to joint
- Divide bone & round ends with rasp
- Bring triceps over bone end & suture tendon to fascia over anterior muscles
- Insert drain deep to fascia, close skin with interrupted nonabsorbable sutures
Proximal to Supracondylar Area
- As per supracondylar area but divide triceps 3.8-5cm distal to level, again suture to anterior fascia
Author Contributions
Page written by Dr James Drummond
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.