Exposure of the humerus and femoral shaft

Henry, Arnold K.

doi:10.1002/bjs.1800124511

Cited by 11 publications

(4 citation statements)

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“…The anterolateral approach which requires splitting of the brachialis may be theoretically safe as the radial nerve is not directly dealt with or explored. In his classic manuscript Henry 1 describes the split brachialis belly as a buffer against the radial nerve and even goes on to claim that in all his exposures he encountered only a single radial nerve injury. As the patient is positioned supine there is an added advantage of easy positioning and anaesthesia, especially in multiple injured patients.…”

Section: Discussionmentioning

confidence: 99%

“…The anterolateral approach and its modifications first described by Henry 1 is widely employed for exposures of the humerus for various pathological conditions and humeral shaft fractures which account for 3%–5% of all orthopaedic injuries. 2 The radial nerve, with its circuitous relationship to the humerus, is of special interest with any surgical exposure of the humeral shaft.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

Gouse

Albert

Inja

et al. 2016

Chinese Journal of Traumatology

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PurposeFractures of the humeral shaft are common and account for 3%–5% of all orthopedic injuries. This study aims to estimate the incidence of radial nerve palsy and its outcome when the anterior approach is employed and to analyze the predictive factors.MethodsThe study was performed in the department of orthopaedics unit of a tertiary care trauma referral center. Patients who underwent surgery for acute fractures and nonunions of humerus shaft through an anterior approach from January 2007 to December 2012 were included. We retrospectively analyzed medical records, including radiographs and discharge summaries, demographic data, surgical procedures prior to our index surgery, AO fracture type and level of fracture or nonunion, experience of the operating surgeon, time of the day when surgery was performed, and radial nerve palsy with its recovery condition. The level of humerus shaft fracture or nonunion was divided into upper third, middle third and lower third. Irrespective of prior surgeries done elsewhere, the first surgery done in our institute through an anterior approach was considered as the index surgery and subsequent surgical exposures were considered as secondary procedures.ResultsOf 85 patients included, 19 had preoperative radial nerve palsy. Eleven (16%) patients developed radial nerve palsy after our index procedure. Surgeons who have two or less than two years of surgical experience were 9.2 times more likely to induce radial nerve palsy (p = 0.002). Patients who had surgery between 8 p.m. and 8 a.m. were about 8 times more likely to have palsy (p = 0.004). The rest risk factor is AO type A fractures, whose incidence of radial nerve palsy was 1.3 times as compared with type B fractures (p = 0.338). For all the 11 patients, one was lost to follow-up and the others recovered within 6 months.ConclusionContrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

Gouse

Albert

Inja

et al. 2016

Chinese Journal of Traumatology

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“…Nevertheless, there are different surgical approaches for treating humeral fractures [10, 11]. The anterolateral approach [12] and its modifications are widely employed for exposure of the humerus in various pathological conditions [13–16]. The anterolateral approach allows supine positioning, which is the most notable advantage for patients with multiple injuries [16].…”

Section: Introductionmentioning

confidence: 99%

Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

Lotzien

Hoberg

Rausch

et al. 2019

BMC Musculoskelet Disord

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BackgroundFractures of the humeral shaft represent 2–4% of all fractures. Fractures of the humerus have traditionally been approached posteriorly for open reduction and internal fixation. Reports of treating midshaft fractures with an open anterolateral approach and anterior plating are limited. The purpose of this study was to evaluate a series of humeral shaft fractures treated with plate osteosynthesis regarding the effect of the approach and plate location on the healing rate and occurrence of complications.MethodsWe conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated with anterior or posterior plate fixation. Selection of the approach to the humerus was based on the particular pattern of injury and soft tissue involvement. The minimum follow-up duration was set at six months. The outcomes included the rate of union, primary nerve palsy recovery, secondary nerve damage, infection and revision surgery.ResultsBetween 2006 and 2014, 58 patients (mean age, 59.9; range, 19–97 years) with humeral midshaft fractures were treated with anterior (n = 33) or posterior (n = 25) plate fixation. After a mean follow-up duration of 34 months, 57 of 58 fractures achieved union after index procedure. Twelve fractures were associated with primary radial nerve palsy. Ten of the twelve patients with primary radial palsy recovered completely within six months after the index surgery. In total, one patient developed secondary palsy after anterior plating, and three patients developed secondary palsy after posterior plating. No significant difference in the healing rate (p = 0.4), primary nerve palsy recovery rate (p = 0.6) or prevalence of secondary nerve palsy (p = 0.4) was found between the two clinical groups. No cases of infection after plate fixation were documented.ConclusionsOpen reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures. An anterior approach allows supine positioning of the patient and yields union and complication rates comparable to those of a posterior approach with plate fixation for the treatment of humeral shaft fractures.

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“…1,2,5,9,14,15,19 Others have suggested partial release of the DI during prosthetic placement for nonunions. 15 We have noted anterior deltoid weakness in patients who have had release of the anterior portion of the deltoid insertion and are concerned that this may compromise a substantial portion of the anterior deltoid.…”

mentioning

confidence: 98%

A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus

Klepps

Auerbach

Calhon

et al. 2004

Journal of Shoulder and Elbow Surgery

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Exposure of the humerus and femoral shaft

Cited by 11 publications

References 0 publications

Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus

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