A lateral approach to the distal humerus following identification of the cutaneous branches of the radial nerve

Abstract

We describe a lateral approach to the distal humerus based on initial location of the superficial branches of the radial nerve, the inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm. In 18 upper limbs the superficial branches of the radial nerve were located in the subcutaneous tissue between the triceps and brachioradialis muscles and dissected proximally to their origin from the radial nerve, exposing the shaft of the humerus. The inferior lateral cutaneous nerve of the arm arose from the radial nerve at the lower part of the spiral groove, at a mean of 14.2 cm proximal to the lateral epicondyle. The posterior cutaneous nerve of the forearm arose from the inferior lateral cutaneous nerve at a mean of 6.9 cm (6.0 to 8.1) proximal to the lateral epicondyle and descended vertically along the dorsal aspect of the forearm. The size and constant site of emergence between the triceps and brachioradialis muscles constitute a readily identifiable landmark to explore the radial nerve and expose the humeral shaft.

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

“…2,3,10 Any discussion about surgical treatment of humeral shaft fractures must first consider the excellent results that can be achieved with nonoperative care of this type of fracture, which has been associated with union rates of more than 90% and with full functional recovery. 3,7,8,11 However, certain fracture types and associated injuries require operative management. Apart from intramedular osteosynthesis, anterolateral and anterior approaches have been used to treat humeral fractures.…”

“…Apart from intramedular osteosynthesis, anterolateral and anterior approaches have been used to treat humeral fractures. [10][11][12] In the anterolateral and anterior approaches, the brachialis muscle is cut to reach the diaphy sis of the humerus. Both these approaches can cause iatrogenic injuries of the radial nerve, and the anterior approach can cause injuries of the musculocutaneous nerve.…”

“…The anterolateral approach is more often used to expose the distal third of the humerus, and the brachialis muscle is cut a bit more laterally. 4,[10][11][12]14 Except for the very end of the distal part of the diaphysis and the proximal third of the diaphysis, both methods involve the same principles of approaching the diaphysis of the humerus. With these approaches, the anterolateral part of the humerus can be exposed; therefore, some authors refer to both methods as the anterolateral approach.…”

“…[10][11][12] The posterior and anterolateral approaches are the most frequently used because they allow access to a larger segment of the humerus. The lateral approach is used for the distal quarter of the humerus.…”

“…The lateral approach is used for the distal quarter of the humerus. 7,8,[10][11][12][13] Surgical treatment carries specific risks related to the close anatomic relationships among the bone, nerves and blood vessels. Iatrogenic injury of the radial nerve occurs in 10%-25% of patients as a result of contusion, stretch or direct damage.…”