Anterior Approach to the Humerus

Anterior approach to the humeral shaft along the lateral border of biceps — Anterior approach to the humeral shaft along the lateral border of biceps. Biceps is retracted medially and brachialis is split to reach the bone. Image from Lotzien S, Hoberg C, Rausch V, Rosteius T, Schildhauer TA, Gessmann J. Open reduction and internal fixation of humeral midshaft fractures, anterior versus posterior plate fixation. BMC Musculoskelet Disord. 2019, 20(1), 527. CC BY 4.0.

Anterior Approach to the Humerus, brachialis muscle, from gray’s anatomy — Brachialis muscle, from Gray’s Anatomy. Image by Me, Wikimedia Commons, Public domain.

Position

Supine
Arm board
Prep & drape arm free

Landmarks

Coracoid
Long head of biceps

Incision

Longitudinal incision along deltopectoral groove & lateral border of biceps
Start:
- Coracoid process

Internervous Plane

Proximally
- Deltoid muscle
  - Axillary nerve
- Pectoralis muscle
  - Medial and lateral pectoral nerves
Distally
- Brachialis split
  - Musculocutaneous nerve (medially)
  - Radial nerve (laterally)

Superficial Dissection

Proximal
- Develop the plane of deltopectoral groove & take cephalic vein laterally
- Deltoid tuberosity & lateral lip of bicipital groove
Distal
- Develop interval between biceps & brachialis
- Retract biceps medially

Deep Dissection

Proximal
- Incise periosteum lateral to insertion of pectoralis major
- Continue proximally, staying lateral to biceps tendon
- Ligate anterior circumflex humeral artery
- If needed
  - Dissect subperiosteally
    - Insertion of pect major
    - Subscapularis
Distal
- Split fibres of brachialis longitudinally
- Strip brachialis off anterior surface of bone
- Subperiosteal dissection

Dangers

Nerve
- Radial
- Axillary nerve
Vessels
- Anterior humeral circumflex

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.