Modified Lateral Approach to the Distal Humerus for Internal Fixation

Moran, Michael C.

doi:10.1097/00003086-199707000-00024

Cited by 51 publications

(35 citation statements)

References 6 publications

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“…By cutting the brachialis muscle, 2 segments with undamaged innervations are exposed. 9,24 These authors also report that the brachialis muscle is bluntly cut between the filaments and that it does not cause major necrosis of the muscle. 9,24,25 Other authors claim that it is not possible to halve the muscle by moving the filaments aside without subsequent major muscle necrosis and that it is not possible to cut the brachialis muscle in such a way that the innervations in the 2 segments are never damaged.…”

Section: Discussionmentioning

confidence: 96%

“…9,24 These authors also report that the brachialis muscle is bluntly cut between the filaments and that it does not cause major necrosis of the muscle. 9,24,25 Other authors claim that it is not possible to halve the muscle by moving the filaments aside without subsequent major muscle necrosis and that it is not possible to cut the brachialis muscle in such a way that the innervations in the 2 segments are never damaged. 10,27,29,30 Mills and colleagues 31 were the first to emphasize the importance of preserving the brachialis muscle on the assumption that it would lead to better outcomes.…”

Section: Discussionmentioning

confidence: 96%

“…Some authors do not attach much importance to the exposure of the musculocutaneous nerve because it is far enough from the location of the incision in the brachialis muscle that they believe it cannot be damaged. 23,24 Other authors consider it necessary to expose the musculocutaneous nerve because its position varies and thus can be placed in the area where we cut the brachialis muscle. 4,10,25,26 With the subbrachial approach, there is no need to expose the musculocutaneous nerve, because it stays inside the brachialis muscle, protected by the muscle tissue, outside of the operative field.…”

Section: Discussionmentioning

confidence: 99%

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

Boschi

Pogorelić²,

Gulan³

et al. 2013

Can J Surg

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RESEARCH • RECHERCHE Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series studyBackground: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. Methods:We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used.Results: During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. Conclusion:The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves. Contexte :Il existe peu d'approches chirurgicales pour corriger la fracture de la diaphyse humérale. Nous présentons ici les résultats que nous avons obtenus avec une approche sous-brachiale.Méthodes : Nous avons réalisé une série de cas rétrospective regroupant des patients ayant subi une chirurgie pour réparation de fracture de la diaphyse humérale entre janvier 1994 et janvier 2008. Nous avons divisé les patients en 4 groupes selon l'approche chirurgicale employée (antérieure, antérolatérale, postérieure et sousbrachiale). Nous avons utilisé une plaque de compression dynamique AO de 4,5 mm.Résultats : Pendant la période de l'étude, 280 patients de 30 à 36 ans ont subi une chirurgie pour fracture de la diaphyse humérale. La durée moyenne de la chirurgie a été la plus courte avec l'approche sous-brachiale (40 min). La perte moyenne de force musculaire a été de 40 %, 48 %, 42 % et 20 % avec les approches antérolatérale, postérieure, antérieure et sous-brachiale, respectivement. La perte moyenne de tension dans le muscle brachial après 4 mois était respectivement de 61 %, 48 %, et 11 % avec les approches antérolatérale, antérieure et sous-brachiale. Seize patients des groupes soumis aux approches antérolatérale et antérieure et 6 patients du groupe soumis à l'approche postérieure ont subi des lésions peropératoires du nerf radial. Aucune complication postopératoire n'a été observée dans...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Boschi

Pogorelić²,

Gulan³

et al. 2013

Can J Surg

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“…Clinical studies using a single-column plate have demonstrated adequate fixation for extra-articular distal humerus fractures [3,5,10]. It appears that some degree of cortical contact is necessary to provide adequate stability to achieve sufficient fixation with a single plate.…”

Section: Discussionmentioning

confidence: 99%

“…Yet despite good functional results, nonunions and infections do occur with double-plating techniques [8,9]. To minimise extensive soft tissue stripping and to decrease surgical time, some authors have used a single posterolateral compression plate for fixation of non-comminuted extra-articular distal humerus fractures [5,8,10]. The advantages of a single plate would include decreased surgical exposure, decreased surgical time and potentially faster rehabilitation due to minimal iatrogenic soft tissue injury.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate

Capo

Debkowska

Liporace

et al. 2013

International Orthopaedics (SICOT)

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Purpose The locking compression extra-articular distal humerus plate (EADHP) is an anatomically shaped, angular stable single-column fixation system for distal third humerus fractures. The purpose of this retrospective study was to evaluate clinical and radiographic outcomes after open reduction and internal fixation of distal humerus fractures with this device. Methods Twenty-one consecutive patients with distal humerus fractures were treated with the EADHP system between February 2006 and June 2012. Of these, 19 were clinically and radiographically evaluated after a mean follow-up of 10.4 months. Follow-up assessment included anteroposterior and lateral radiographs, assessment of range of motion (ROM), pain according to a visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results All fractures demonstrated satisfactory reduction and healing at an average of 7.3 months. One patient showed postoperative sensory ulnar neuropathy that recovered completely, and nine patients had a preoperative radial nerve palsy, which recovered spontaneously following exploration and plating. Mean post-operative ROM was as follows: flexion 126°, extension −7°, pronation 82°and supination 83°. The VAS score was zero points in eight patients, while the mean DASH score was 25.8 points.Conclusions For extra-articular distal humerus fractures, including high-energy injuries often seen in gunshot wounds or motor vehicle injuries, the anatomically shaped angular stable single-column plate provides satisfactory clinical and radiographic results and serves as a valuable tool in the treatment of these injuries.

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Principles of Fixation for Distal Humerus Fractures

Blonna

Bellato

2014

Simple and Complex Fractures of the Humerus

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Modified Lateral Approach to the Distal Humerus for Internal Fixation

Cited by 51 publications

References 6 publications

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

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

Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate

Principles of Fixation for Distal Humerus Fractures

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