Exposures of the Humerus for Fracture Fixation

Capo, John T.; Criner, Katharine; Shamian, Ben

doi:10.1016/j.hcl.2014.07.001

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…The LABCN is encountered between the brachialis muscle and the distal biceps tendon 16 in the traditional anterior Boyd-Anderson approach to the distal humerus 17 . The s-shaped skin incision that is made to access the anterior aspect of the humerus may be extended distally and medially to approach the coronoid, lacertus fibrosus, and median nerve (Fig.…”

Section: Discussionmentioning

confidence: 99%

Computer-Assisted Surgical Anatomical Mapping of the Antebrachial Cutaneous Nerves

et al. 2023

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Background: It is common practice to assess the distance from nerves to anatomical structures in centimeters, but patients have various body compositions and anatomical variations are common. The purpose of this study was therefore to assess the relative distance from cutaneous nerves around the elbow to surrounding anatomical landmarks by providing a stacked image that displays the average position of cutaneous nerves around the elbow. The aim was to research possibilities for adjusting common skin incisions in the anterior elbow so that cutaneous nerve injury may be avoided. Methods:The lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) were identified in the coronal plane around the elbow joint in 10 fresh-frozen human arm specimens. Marked photographs of the specimens were analyzed using computer-assisted surgical anatomical mapping (CASAM). Common anterior surgical approaches to the elbow joint and the distal humerus were then compared with merged images, and nerve-sparing alternatives are proposed. Results:The arm was divided longitudinally, from medial to lateral in the coronal plane, into 4 quarters. The LABCN crossed the central-lateral quarter of the interepicondylar line (i.e., was somewhat lateral to the midline at the level of the elbow crease) in 9 of 10 specimens. The MABCN ran medial to the basilic vein and crossed the most medial quarter of the interepicondylar line. Thus, 2 of the quarters were either free of cutaneous nerves (the most lateral quarter) or contained a distal cutaneous branch in only 1 of 10 specimens (the central-medial quarter). Conclusions:The Boyd-Anderson approach, which is often used to access anteromedial structures of the elbow, should be placed slightly further medially than traditionally advised. The distal part of the Henry approach should deviate laterally, so that it runs over the mobile wad. In distal biceps tendon surgery, the risk of cutaneous nerve injury may be reduced if a single distal incision is placed slightly more laterally (in the most lateral quarter), as in the modified Henry approach. If proximal extension is required, LABCN injury may be prevented by using the modified Boyd-Anderson incision, which runs in the central-medial quarter.Clinical Relevance: Cutaneous nerve injury may be prevented by slightly altering the commonly used skin incisions around the elbow on the basis of the safe zones that were identified by depicting the cumulative course of the MABCN and LABCN using CASAM.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A522).

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Section: Discussionmentioning

confidence: 99%

Computer-Assisted Surgical Anatomical Mapping of the Antebrachial Cutaneous Nerves

et al. 2023

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“…The length of the plate was adjusted to the fracture site and the location of the distal incision was determined under fluoroscopy. For the distal incision, anterior approach between biceps tendon or biceps and brachioradialis muscle was used [3, 4]. In this incision, radial nerve was not explored.…”

Section: Methodsmentioning

confidence: 99%

Narrow locking compression plate vs long philos plate for minimally invasive plate osteosynthesis of spiral humerus shaft fractures

Jeong

Park

Lee

et al. 2019

BMC Musculoskelet Disord

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Background Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension. Methods From January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up. Results All patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time ( p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures. Conclusions In spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.

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“…Surgical treatment is usually reserved when conservative treatment fails (irreducible fracture or unacceptable reduction, nonunion or malunion), for open fractures that require debridement and stabilization, in cases of neurovascular injury, in polytrauma, in fractures extended into the joints, in floating elbow and in patients who request the possibility of early mobilization 15,16 . The ultimate goal of fixation is rigid stabilization to allow early range of motion, protection of the neurovascular structures and preservation of the tricep function posteriorly and the elbow flexor muscles anteriorly 17,18 , so knowledge of the complex neurovascular anatomy of the arm is imperative to accomplish a safe surgical approach. Radial nerve injury after humeral shaft fractures has an overall incidence of 11.8%, representing the most common peripheral nerve injury associated with bone fractures 1,19 .…”

Section: Operative Treatmentmentioning

confidence: 99%

“…Multiple approaches to the posterior humerus have been described, including the anterior, anterolateral, lateral, posterior and modified posterior: radial nerve is at considerable risk in each of these approaches. Its dentification during the surgical approach allows for protection and aids in its identification in the event of a future revision surgery 17,23,24 . Gerwin et al found that the radial nerve traversed the posterior humerus 20.7 ± 1.2 cm proximal to the medial epicondyle to 14.2 ± 0.6 cm proximal to the lateral epicondyle 25 .…”

Section: Open Reduction and Plate Fixationmentioning

confidence: 99%

Outcome of humeral shaft fractures

et al. 2020

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Humeral shaft fractures represent approximately 3% of all long-bone fractures and have historically been treated successfully in a non-operative way, but surgical management is indicated in several conditions. Although there are numerous randomized clinical trials and meta-analyses that have attempted to guide surgeons, there is little evidence and no consensus as to the most suitable treatment. Every treatment has its advantages and its complications, and many factors must be considered: not only the features of the fracture, but also patient compliance and surgeon experience.

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Exposures of the Humerus for Fracture Fixation

Cited by 3 publications

References 22 publications

Computer-Assisted Surgical Anatomical Mapping of the Antebrachial Cutaneous Nerves

Computer-Assisted Surgical Anatomical Mapping of the Antebrachial Cutaneous Nerves

Narrow locking compression plate vs long philos plate for minimally invasive plate osteosynthesis of spiral humerus shaft fractures

Outcome of humeral shaft fractures

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