Surgical Exposures of the Humerus

@article{Zlotolow2006SurgicalEO,
  title={Surgical Exposures of the Humerus},
  author={Dan A Zlotolow and Louis W. Catalano and Alton O. Barron and Steven Z. Glickel},
  journal={Journal of the American Academy of Orthopaedic Surgeons},
  year={2006},
  volume={14},
  pages={754–765}
}
&NA; The neurovascular and muscular anatomy about the humerus precludes the use of a truly “safe” fully extensile approach. Working around a spiraling radial nerve at the posterior midshaft requires either a transmuscular dissection or a triceps‐avoiding paramuscular technique. To gain maximal exposure, the radial nerve must be mobilized at the spiral groove. For exposure of only the proximal humeral shaft, many surgeons prefer the anterolateral approach because it uses the internervous plane… 

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References

SHOWING 1-10 OF 29 REFERENCES
Extensor mechanism-sparing paratricipital posterior approach to the distal humerus.
TLDR
In extra-articular and simple articular distal humeral fractures with simple or multifragmentary metaphyseal involvement (OTA type C1 and C2), extensile approaches may not be necessary and an alternative exposure is the extensor mechanism-sparing paratricipital posterior approach to thedistal humerus through a midline posterior incision.
A minimally invasive approach for plate fixation of the proximal humerus.
TLDR
This surgical approach allows exposure of the proximal humerus and indirect reduction of the fracture, with subsequent locking plate fixation, adhering to the principles of biological fixation.
Posterior extensile approach to the elbow joint and distal humerus.
Between 1986 and 1990, the authors treated 14 intra-articular fractures of the distal humerus using a posterior extensile approach. This approach, a combination of a triceps-splitting approach and an
Posterior approaches to the humerus: when should you worry about the radial nerve?
TLDR
The olecranon osteotomy approach to the humerus was used and measured where the radial nerve pierced the intermuscular septum to determine the risk to that nerve during elevation of the triceps to find the nerve an average of 10.0 cm from the distal articular surface in men and 9.4 cm in women.
The surgical anatomy of the radial nerve around the humerus.
  • T. Guse, R. Ostrum
  • Medicine, Biology
    Clinical orthopaedics and related research
  • 1995
TLDR
The radial nerve passed anterior to the long head of triceps and cross onto the posterior shaft of the humerus an average of 124 mm below the posterior tip of the acromion, and was never within 100 mm of either epicondyle.
Extensive posterior exposure of the elbow. A triceps-sparing approach.
TLDR
This approach, which provides extensive exposure to the elbow joint, has been employed in 49 consecutive total elbow arthroplasties and results show no loss of triceps function and no significant weakness.
A posterior surgical approach to the proximal part of the humerus.
TLDR
At least eight centimeters of the posterior aspect of the proximal region of the humeral diaphyseal cortex can be exposed through the interval between the lateral head of the triceps and the deltoid muscle in the dissection of an eleven-year-old boy.
Alternative Operative Exposures of the Posterior Aspect of the Humeral Diaphysis. With Reference to the Radial Nerve*
TLDR
The radial nerve trifurcated into a branch to the medial head of the triceps, the lower lateral brachial cutaneous nerve, and the continuation of the radial nerve into the distal part of the upper arm and the forearm.
Combined olecranon osteotomy and posterior triceps splitting approach for complex fractures of the distal humerus.
TLDR
This technique was used in two patients who presented with severe intercondylar fractures of the distal humerus and extension proximally to the midshaft of the Humerus.
...
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