Maintains ability to rotate humerus — extremely useful in being able to control a prosthesis
Humeral condyles allow for easier prosthetic fitting
Can add distal humerus osteotomy — 45deg anterior angulation
- Allows for prosthesis fitting and reduces need for a shoulder harness
Better for paediatrics
- Prevents bony overgrowth in paediatrics seen with transhumeral amputations and allows for normal distal humeral growth
Technique
- Equal anterior & posterior skin flaps
- Begin proximally at level of epicondyles & extend posteriorly to 2.5cm distal to olecranon & anteriorly just distal to insertion of biceps tendon
- Start medially & divide:
- Lacertus fibrosus
- Free flexor origin
- Expose NV bundle medial to biceps
- Proximal to joint isolate/ligate/divide brachial artery
- Divide median nerve sharply so it retracts at least 2.5cm proximal to joint
- Divide ulnar nerve
- Release biceps & brachialis distally
- Divide radial nerve
- Identify radial nerve between brachialis & brachioradialis & divide sharply
- Posteriorly 6.3cm distal to joint
- Divide extensors transversely & reflect proximally
- Divide triceps tendon near tip of olecranon,
- Divide anterior capsule & remove forearm
- Bring triceps tendon anteriorly & suture to tendons of biceps & brachialis,
- Bring flap of extensors left attached to lateral epicondyle medially
- Suture to remnants of flexor mass at medial epicondyle
- Ensure all bony prominences & tendons covered
- Insert drain deep to fascia
- Close skin edges with interrupted nonabsorbable sutures
Author Contributions
Page written by Dr James Drummond
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.