Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Extensile Surgical Exposures: Humerus
Introduction
Occasionally, it becomes necessary to perform extensile surgical exposures to the humerus for trauma, malignancy or revision elbow surgery with periprosthetic fracture, or severe and significant bone loss where allograft prosthetic composites are planned. In this chapter, we will cover the three most utilitarian approaches to the humerus, including the extensile anterior lateral approach, the extensile posterior medial approach, and the posterior triceps-splitting approach. All of the approaches necessarily require identification and protection of the neurovascular structures in the brachium, which is typically the most anxiety-inducing aspect of the exposures, particularly in the revision setting where scarring makes dissection of the nerves extremely difficult. The topics are well covered in general texts, but herein we focus on the relevance to elbow surgery.
Extensile Anterior Lateral Approach of the Humerus
The classic anterolateral approach characteristically exposes the distal third of the humerus. The extensile anterolateral approach extends this exposure, both distally and proximally, and allows for exposure of nearly the entire humerus.
Positioning
This approach can be performed with the patient in the supine position or beach chair position, which may be necessary if a shoulder implant also requires exposure. The patient can be tilted 10 degrees to the contralateral direction for easier access, and the forearm is placed across the abdomen. The patient should be draped to include the shoulder and arm proximally to allow extension to the clavicle for exposure of the shoulder joint through the deltopectoral interval if necessary.
Landmarks
The landmarks for this approach include the biceps brachii in the antecubital fossa, as well as the deltopectoral interval proximally. The deltoid insertion can be readily palpated on thin patients and is an excellent landmark for the longitudinal portion of the incision ( Fig. 10.1 ). The midportion of the distal exposure is facilitated by palpation of the lateral column, which marks the division between the anterior and posterior compartments of the arm and is relatively avascular.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here