Surgical Management
Fixation
Precontoured anatomical plates
Synthes long posterolateral distal humerus plate
Synthes distal humerus plates surgical technique PDF
Approach
Triceps split
Lateral paratricipital approach / Modified Gerwin
Triceps split
AO foundation surgical approach
Technique
- lateral approach with arm over bolster
- midline incision
- split deep fascia
Proximally
- interval between long and lateral heads of triceps
- release lateral head from insertion on humerus
- limited by deltoid / axillary nerve / posterior circumflex humeral artery proximally
- identify radial nerve / profunda brachii artery in spiral groove
Distally
- split triceps tendon
- reflect medial head of triceps from bone medially / divide medial head of triceps
- care of ulna nerve which emerges posteriorly through medial intermuscular septum
Lateral paratricipital / Modified Gerwin
AO foundation radial window distal humerus
Indication
Holstein Lewis / distal humerus fracture
Approach
Patient lateral with arm over bolster
A. Mobilise the lateral triceps medially from lateral intermuscular septum
B. Identify and protect the radial nerve lateral to triceps
- pierces the lateral intermuscular septum 10 from articular surface elbow
- enters spiral groove 14 cm above lateral epicondyle
- posterior antebrachial cutaneous nerve arises here from radial nerve
- may have to elevate the radial nerve and pass the plate under
- apply precontoured long posterolateral distal humerus plates
Release and protect radial nerve, and place plate under nerve
Posterolateral plate
C. Can use proximal window between long and lateral heads
- slide plate under radial nerve
- fix with screws proximal and distal
Triceps sparing posteromedial approach
Identify and protect ulna nerve
- distally in cubital tunnel, between two heads of FCU
- proximally passes posterior through medial intermuscular septum at midpoint arm
Mobilize medial triceps
Ulna nerve protect medially, and the triceps then mobilized laterally to apply medial plate