Anterolateral Approach to the Distal Humerus

Distal anterolateral incision on the arm with the radial nerve looped in the interval between brachialis and brachioradialis
Distal anterolateral incision on the arm with the radial nerve looped in the interval between brachialis and brachioradialis. A separate proximal incision is also visible. Image from Jeong JJ, Park SE, Lee HH, Ji JH, Park MS, Park YT. Narrow locking compression plate vs long philos plate for minimally invasive plate osteosynthesis of spiral humerus shaft fractures. BMC Musculoskelet Disord. 2019, 20(1), 381. CC BY 4.0.
Gray’s Anatomy illustration of the radial nerve
The suprascapular, axillary and radial nerves. In the anterolateral approach to the distal humerus the radial nerve lies between brachialis and brachioradialis. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

Indications

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

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

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