This ends up in a liberated muscle complex containing the long head, lateral head and the medial head of the triceps. Pol Rommens, Peter Trafton, Martin Jaeger. Incise the deep fascia in line with the skin incision. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Data Trace Publishing Company The triceps-sparing posterior approach to the humerus results in high union rates and a low incidence of secondary radial nerve palsy. This retains the musculotendinous integrity of the triceps and allows more rapid postoperative rehabilitation. This ends up in a liberated muscle complex containing the long head, lateral head and the medial head of the triceps. The posterior triceps-splitting approach exposed an average of 15.4 +/- 0.8 centimeters of the humerus from the lateral epicondyle to the point at which the radial nerve crossed the posterior aspect of the humerus. If necessary dissect remaining muscle fibers, still attached to the posterior aspect of the humerus, from the lateral side. Next, mobilize the triceps muscle and retract it laterally. The entire triceps muscle is isolated with a gauze wrap (2). Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. This provides adequate exposure for reduction and fixation. Telephone: 410.494.4994, Anterior transposition of the radial nerve--a cadaveric study, Radial nerve location at the posterior aspect of the humerus: an anatomic study of 100 specimens, A posterior surgical approach to the proximal part of the humerus, Posterior Acetabular Wall Frx: Danger Zone, Orthopaedic Specialists of North Carolina. The incision runs proximally in a straight line from the olecranon along the posterior midline of the arm. 110 West Rd., Suite 227 Posterior approaches to the humerus: when should you worry about the radial nerve? Alternative Operative Exposures of the Posterior Aspect of the Humeral Diaphysis with Reference to the Radial Nerve. If necessary dissect remaining muscle fibers, still attached to the posterior aspect of the humerus, from the lateral side. Towson, MD 21204 The humerus was also approached via a triceps split and the nerve located at the spiral groove. Just above the tip of olecranon the incision was curved For midshaft and distal shaft fractures, the posterior approach may be extended distally, leaving the triceps insertion intact. In the case shown here, going up into the diaphysis, the ulnar nerve was identified and held with a vessel loop (1). It may be helpful to protect it with a vessel loop. Proximally, follow the ulnar nerve along its course on the medial intermuscular septum. Wheeless' Textbook of Orthopaedics. Data Trace is the publisher of The distance from the articular surface to the nerve averaged 15.8 cm in men and 15.2 cm in women, with the minimum distance being 13 cm in one woman. This permits the whole triceps muscle to be moved towards either the lateral or medial side, to provide access to the humerus (“triceps flip”). This is a large consecutive series of humeral shaft fractures treated with plating through a posterior approach by a single surgeon. Surgical Exposure – Posterior approach to distal humerus was followed Surgical steps Bony landmarks are marked including olecranon process, subcutaneous border of ulna, medial and lateral epicondyles. nerve crosses posterior aspect of humerus at 20-21 cm proximal to medial epicondyle and 14-15 cm proximal to lateral epicondyle Please rate topic. - Humeral Mid-Shaft Frx are also amenable to the posterior approach if the formal approach is modified (see below); - Position: lateral position, injured side up; Alternative Operative Exposures of the Posterior Aspect of the Humeral Diaphysis with Reference to the Radial Nerve. This permits the whole … The complete incision is illustrated. It crosses the radial nerve in the mid-humeral region and the axillary nerve proximally. Split the triceps fascia and mobilize the lateral head of the triceps from the lateral intermuscular septum and humerus towards the ulnar side. This may be achieved by bluntly dissecting the medial head of the triceps from the posterior aspect of the humerus. Join from wherever you are in the world. Average 4.3 of 13 Ratings Split the triceps fascia and mobilize the lateral head of the triceps from the lateral intermuscular septum and humerus towards the ulnar side. - Indications: Incision – A posterior mid-line longitudinal incision was made over lower arm and extended distally beyond the elbow joint. Close the wound in layers in a standard manner. A posterior surgical approach to the proximal part of the humerus. December 3-6, 2020, Hip periprosthetic fracture module is now online. IntroductionThe optimal treatment of humeral shaft fractures continues to be debated. The radial nerve can be detected at its penetration through the intermuscular septum and followed upwards in the radial groove. Note: Take care that the protecting vessel loop does not injure the ulnar nerve by uncontrolled traction. - Distal Third Humeral Fractures: As a first step, identify and mobilize the ulnar nerve. Clifford R. Wheeless, III, M.D. Orthopaedic Specialists of North Carolina. Depending on the fracture location the exposure may need to be extended distally. Three operative approaches were performed in each specimen. Posterior approaches to the humerus: when should you worry about the radial nerve? Depending on the fracture and its location a smaller section might be used. The triceps is elevated off the posterior humerus, but its insertion is not disturbed. Do not use heavy clamps to secure the loop. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. Incise the skin, beginning at the tip of the olecranon.
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