This is because of the complicated anatomy of the medial aspect of the upper arm. Abstract the minimal anterolateral acromial approach offers a less invasive access to the proximal humerus. Anterior approach to the humerus orthopaedicsone articles. Anterolateral and direct lateral approach for total hip. I just look for my defining characteristics that i can associate with the anterior front or posterior back of the humerus. Lateral approaches to the proximal humerus have been limited by the position of the axillary nerve. Functional impairment following this procedure may be caused by paresis of the deltoid muscle as a result of iatrogenic injury to the axillary nerve. The median, ulnar, musculocutaneous, and radial nerves travel within the arm, surrounding the humerus. Orif of proximal humerus fracture through an anterolateral.
The bony landmarks of the corocoid anteriorly, the ac jointanterior tip of the acromion laterally and the spine of the scapula posteriorly are identified. The authors propose an original route of approach to the shoulder that allows direct access to this articulation. This approach has recently been popularized for the copeland resurfacing and delta reversegeometry prostheses. Most radial nerve palsies are found at presentation due to the initial trauma. However, it can also be taken in the supine position. In the anterolateral approach, herbert screws, which compress the fracture site from an anterior to posterior direction on the distal humerus, appear to be sufficiently strong to maintain the. Using a modification of this approach, we describe its use in a group of patients requiring either internal fixation or hemiarthroplasty for proximal humeral fracture and the effect of this approach on the postoperative function on the axillary nerve and deltoid muscle. One of the structures at risk during this approach. Twentythree patients were evaluated clinically at a minimum followup of 1 year average, 28 months by clinical examination for range of motion and. Intraoperative evaluation of the radial nerve during. Surgical approaches for revision of humeral shaft fractures, including malunion or nonunion, present a challenging soft tissue dissection due to prior scarring and injury, increasing the risk of radial nerve injury. Preoperatively all 44 patients had documented normal motor function of all three parts of deltoid muscle with intact sensory function of axillary nerve.
Fractures of the humeral shaft a free powerpoint ppt presentation displayed as a flash slide show on id. The anterolateral acromial approach was developed to allow less invasive treatment of proximal humerus. Multiple parameters were measured regarding the axillary nerve. Orif of the proximal humerus through an anterolateral. T1 supine extensile approach to the anterolateral humerus. This article is from the open orthopaedics journal, volume 5.
The anterolateral approach discussed in this study is appropriate for all types of lateral condylar fractures in children. We strongly suggest an anterolateral approach as the optimal approach for lateral humeral condylar fractures. Lateral intermuscular septum as cause of radial nerve. However, the furlong diagnostic acumen was the falsification of the furlong thereafter had a spruce up of numbness on the butter. Choosing surgical approaches to proximal humerus fractures duration. The anterolateral approach to the proximal humerus for. The anterolateral acromial approach for fractures of the. Plate fixation is the gold standard for the surgical management of humeral midshaft fractures, and the anterolateral approach is most commonly used 47. Make a curved incision from the tip of the coracoid process distally in line with deltopectoral groove along the lateral aspect of the humerus. Anterolateral and direct lateral approach for total hip arthroplasty. Anterolateral versus posterolateral approach to the fractured. The patient is placed on her side and a straight incision of about 10 centimetres is made down the thigh centred on the greater trochanter. Internal fixation for coronal shear fracture of the distal.
An anterosuperior approach for proximal humeral fractures. The anterolateral approach to the tibia has been popularized for management of tibial pilon fractures. However, for sufficient fixation space, the lateral supracondyle of the humerus should be exposed through an extra incision. The ao teaching video special edition esin and animations are available for free online. Musadiq khan durrani 1 musadiq khan durrani ucmd university of lahore 2. Dec 06, 2011 the purpose of this study is to compare the anterolateral to posterolateral approaches in patients suffering a displaced femoral neck fracture operated with an hip arthroplasty. Lister retired from custom in 1896 but contin ued his scienti. Twenty cadaver shoulders were dissected using the extended anterolateral acromial approach through the anterior deltoid raphe. Fracture humerus shaft in adults auditkhoula hospital.
Electrophysiological assessment of the deltoid muscle. With respect to the fracture configuration, the superolateral approach is generally chosen because it provides greater access to the greater tuberosity and requires minimal softtissue dissection when compared with the deltopectoral approach. Most fracture reductions and manipulations can be performed through a wide operative field using the anterolateral approach. This approach offers the benefit of improved soft tissue coverage and the potential for a. Surgical exposures of the humerus the neurovascular and muscular anatomy about the humerus precludes the use of a truly safe fully extensile approach. With the arm stretched out on a hand table and the patient positioned supine, the fracture was exposed through an anterolateral approach using a previously described technique. Incision should end approximately 5 cm short of elbow flexion crease lateral antebrachial cutaneous nerve at risk superficial dissection.
Our hypothesis is that the anterolateral approach gives equal or better clinical function, health related quality of life and less complication and reoperations. Orif through an anterolateral acromial approach michael gardner, md by orthopaedic trauma association on vimeo. An extended anterolateral approach was utilized as described by gardner et al. Delayed radial nerve palsy after closed reduction of a. Surgical technique for open reductioninternal fixation of. Anterolateral approach to the humerus extended lateral approach to the humerus medial approach to the humerus. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. An extensile approach to the humerus is utilized for this procedure comprising a combination of the standard deltopectoral approach to the shoulder, anterolateral approach to the humerus, and anterior approach to the elbow 22, 23.
Orif of the proximal humerus through an anterolateral acromial approach. Choosing surgical approaches to proximal humerus fractures. The plate often needs to be prebent during placement. Pdf anterolateral deltoidsplitting orif may avoid avn in.
Modified combined approach for distal humerus shaft fracture. Anterolateral approach to distal humerus posterior approach to humerus. The incision is modified to incorporate excision of the previous biopsy tract whenever required. Jcm free fulltext fractures of the humeral shaft with. Traditional approaches to the humerus such as the anterior or anterolateral approach ala assume homogenous brachialis muscle morphology with fibres that run parallel to the humeral shaft. Previous authors have described an anterolateral approach to the humerus limited by the radial. The aim of this study is to explore the management and outcomes of humeral midshaft fractures fixed through a medial incision. The purpose of this study was to assess the influence of injury mechanism, fracture type, and treatment on nerve recovery in patients with humeral shaft fractures and primary nerve palsy. The purpose of our study was to explore a direct anterolateral, less invasive approach to the proximal humerus. Orif through an anterolateral acromial approach michael gardner, md by orthopaedic trauma association on vimeo, ota video library proximal humerus fractures. Using an anterolateral humerus approach combined with a kocher elbow approach, an extensile humeral exposure appeared to be a safe procedure without evidence of radial nerve injury in this case. Background the deltopectoral approach is a welldescribed surgical approach to the proximal humerus and glenohumeral joint.
An extended deltopectoral approach allows the surgeon to extend the exposure distally utilizing an anterolateral approach to the humerus, if needed. A 6 to 8cm incision is made at the anterolateral aspect of the acromion fig 2. The cephalic vein is the landmark for this interval. Keeping their sanitation is commonly fairly problematic and also challenging, given that it is a big area of the properties and the surrounding area, there are many washrooms as well as spaces for different purposes. The anterolateral intertubercular approach to the shoulder. Orif of a valgus three part proximal humerus fracture through the anterolateral acromial approach, using the raphe between the anterior and middle heads of the deltoid and identification of the axillary nerve. In the anterolateral approach, the lateral aspect of the humerus is uneven, often leading to medial gapping during fixation fig. Omar al bardan only the paranoid survive 12,077 views. A modified combined anterolateral and lateral approach for the treatment of distal humeral fracture and nonunion ensures an easy approach to the entire humerus, a lowered risk of radial nerve injury and the performance of complicationfree revision surgery during the distal humerus approach and harmless revision surgery during the distal. Over a 4year period, 52 patients with acute displaced fractures of the proximal humerus were treated with the anterolateral acromial approach and either a locking plate or an intramedullary nail. The extended anterolateral acromial approach allows.
Oct 01, 2014 this feature is not available right now. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. During the medial approach, the plate can be placed without being reshaped onto the smooth anteromedial humerus. However, the medial approach is rarely discussed for humeral shaft fracture management. Ota video library surgical technique anterolateral. Proximal humerus anterior approach the deltopectoral approach is the workhorseexposurefortheproximal humerus. Gardner mj1, griffith mh, dines js, briggs sm, weiland aj, lorich dg.
This approach should also restore the posterior blood supply to the lateral condyle. Extended anterolateral approach cambridge orthopaedics. Surgical approaches posterior approach to the humerus m4 triceps splitting approach to the humerus m5. Anterior approach to the humerus thompson, henry aims. Proximally, the subcutaneous tissue was divided to expose. Dissection was carried down to the biceps, which was retracted medially. Proximal humerus fractures orif through an anterolateral. The patient was administered regional anesthesia and positioned in a sloppy lateral position. Adult humeral shaft fractures are associated with primary radial nerve palsy in up to 18% of cases. Oct 12, 2010 how can you tell the anterior front and posterior back of the humerus. Anterolateral approach results in less pain, quicker recovery and faster return to an active lifestyle. This video demonstrates the anterolateral acromial approach for orif of proximal humerus fractures, with some additional reduction techniques. Anterolateral approach for trauma shoulderdoc by prof. Total humeral endoprosthetic replacement following.
The deltopectoral approach to the shoulder requires extensive soft tissue dissection and muscle retraction to gain adequate exposure of the lateral aspect of the humerus. Orif of proximal humerus fracture through an anterolateral approach. However, the outcomes of humeral shaft fracture fixation using a medial approach are rarely reported. Presented in this video are surgical techniques of an anterolateral approach to the humerus, illustrated in the case of a humeral shaft fracture treated with open reduction and internal fixation. The medial approach does not require a prebent plate and creates a large operative exposure. This approach develops the internervous plane between the deltoid axillary nerve and the pectoralis major medial and lateral pectoral nerves. Modified combined approach for distal humerus shaft. Mar 17, 2016 plate fixation is the gold standard for diaphyseal fracture management, and the anterolateral approach is widely used by reconstructive surgeons. Anterolateral approach for the treatment tibial plateau. Working around a spiraling radial nerve at the posterior midshaft requires either a transmuscular dissection or a tricepsavoiding paramuscular technique. Currently, there are a few surgical approaches for treating humeral fractures.
The anterolateral acromial approach for fractures of the pro. Safe humeral component extraction requires adequate exposure of the proximal humerus, regardless of technique utilized. Surgical technique anterolateral approach to the humerus liskutin 2 years ago presented in this video are surgical techniques of an anterolateral approach to the humerus, illustrated in the case of a humeral shaft fracture treated with open reduction and internal fixation. If you continue browsing the site, you agree to the use of cookies on this website.
Please vote below and help us build the most advanced adaptive learning platform in medicine. Many fractures of the tibial plateau can be treated with an anterolateral approach to the proximal tibia. The projection demonstrates the humerus in the lateral position allowing for adequate radiographic examination of the entire humerus and its respected articulations. This surgical approach to managing pediatric fractures is explained in more than 30 illustrated cases with detailed stepbystep descriptions. The extended anterolateral acromial approach allows minimally. The medial approach to the humerus had equivalent outcomes to anterolateral fixation. Surgical risks, benefits and alternatives were discussed and the patient elected to proceed with left radial nerve neurolysis and decompression.
Proximal humerus fractures orif through an anterolateral acromial approach september 05, 20 contributors. Orif through an anterolateral acromial approach michael gardner, md on vimeo. Anterolateral deltoidsplitting orif may avoid avn in proximal humerus fractures. We think that we have proved the minimally invasive anterolateral approach is a safe and reproducible tool. Using this minimally invasive technique and minimizing soft tissue injury, anterolateral hip replacement in mexico streamlines the process for hip replacement patients. The modified anterolateral approach to the humerus.
The placement of a plate on anterolateral surface of humerus. Medial approach to treat humeral midshaft fractures. An anterolateral approach to the humerus was utilized with the incision centered over the point of maximal tenderness. The modified anterolateral approach is the most commonly used approach in contemporary hip replacement surgery. Lateral approach to distal humerus approaches orthobullets. N2 the radial nerve is at risk of injury during surgical approaches to the humeral shaft. Download this book presents a guide to elastic stable intramedullary nailing esin in children. Thanks to this route, complex fractures of the proximal end of the humerus can be treated by ostosynthesis or prosthesis, and shoulder arthroses, whether centered or not by prosthesis.
Anterolateral approach to the humerus m1566 extended lateral approach to the humerus m7. Pdf medial approach to treat humeral midshaft fractures. Humeral shaft fractures are common in the united states and may be associated with radial nerve injuries due to their close anatomic relationship in the spiral groove. Additional, we demonstrate the use of a verbrugge to achieve axial compression across the fracture plane. The deltoid insertion was partially elevated to obtain space for. Therefore the anterolateral approach is superior to the lateral or posterior approach for coronal shear fracture of the distal end of the humerus. Anterior brachialis splitting approach to humerus anterolateral approach to distal humerus posterior approach to humerus.
Modified anterolateral approach hip replacement and recovery. It is an available choice for humeral midshaft fracture fixation in cases where there is no need to expose the radial nerve. Perform arthrotomy to expose the joint for reduction. Using this approach, we have performed 25 23 for acute fracture, 2 for nonunion internal fixations of the proximal humerus and 19 stemmed arthroplasties for humeral head fractures.
Cleaning up cottages or cottages is a popular service among proprietors of country houses. We present our technique for this approach with special focus on performing a submeniscal arthrotomy, placing a femoral distractor and elevation of the joint surface. Supine extensile approach to the anterolateral humerus. The lateral approach is used for the distal quarter of the humerus. How to tell the anterior from the posterior of the humerus. Successful surgical treatment requires finding the appropriate balance between adequate exposure for reduction and rigid fixation and minimizing soft tissue dissection. Lateral view of the humerus is part of the humerus series and is usually taken in standing position.
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