Humeral Shaft Fracture Approaches

Anterolateral Approach to humeral shaft fracture.

• Adequate for: proximal 1/3, midshaft fx,distal 1/3 fx,
• Postion: supine or modified beach chair
• Incision: longitudinal just lateral to biceps.
• Proximal exposure between deltoid and pec major insertions.
• Distal exposure splits brachialis origin off humerus with medial retraction of biceps muscle.
• Extension: can be extended into deltopectoral approach to the proximal humerus.
• Risks: Radial nerve, lateral antebrachial cutaneous nerve, cephalic vein.

1. Cephalic vein
2. Lateral antebrachial cutaneous nerve
3. Radial nerve
4. Brachialis origin

Posterior Approach to humeral shaft fracture

• Adequate for: midshaft fx,distal 1/3 fx, radial nerve palsy

1. Lateral Brachial cutaneous nerve
2. Radial nerve
3. Profunda brachii artery
4. Triceps - medial (deep) head
5. Ulnar nerve

Anteromedial Approach to humeral shaft fracture

• Rarely used
• Anteromedial incision proximal to medial epicondyle
• Dissection posterior to intermuscular septum
• Ulnar nerve freed from triceps and reflected medially.
• Median nerve and brachial artery reflected laterally.
• Risks: Ulnar nerve, median nerve, brachial artery.

1. Ulnar nerve
2. Brachial artery and veins
3. Median nerve
4. Cephalic vein