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Posterior approach to humerus
- 1. POSTERIOR APPROACH TO HUMERUS DR. BIPUL BORTHAKUR (PROF.) DEPT OF ORTHOPAEDICS, SMCH
- 2. INTRODUCTION • 3 BASIC APPROACHES POSTERIORLY – POSTERIOR APPROACH TO THE PROXIMAL HUMNERUS – POSTERIO-LATERAL APPROACH TO DISTAL HUMERAL SHAFT – POSTERIOR APPROACH FOR MIDDLE TWO-THIRD
- 3. POSTERIOR APPROACH TO THE PROXIMAL HUMERUS AXILLARY NERVE AND POSTERIOR CIRCUMFLEX HUMERAL ARTERY RADIAL NERVE AND PROFUNDA BRACHII ARTERY LATERAL HEAD OF TRICEPS MEDIAL HEAD OF TRICEPS LONG HEAD OF TRICEPS
- 4. • EXPOSES THE BONE THROUGH THE INTERVAL BETWEEN – LATERAL HEAD OF TRICEPS – DELTOID • 8cm BONE CAN BE EXPOSED APPROX.
- 5. • EXTENT OF THE APPROACH 1. PROXIMALLY- AXILLARY NERVE POSTERIOR CIRCUMFLEX HUMERAL ARTERY 2. DISTALLY- ORIGIN OF TRICEPS FROM LATERAL BORDER OF SPIRAL GROOVE UNDERLYING RADIAL NERVE
- 6. TECHNIQUE • POSITION – LATERAL WITH EXTRIMITY DRAPED FREE AND POSITIONED ACROSS THE CHEST
- 7. INCISION • PROXIMALLY – 5cm DISTAL TO POSTERIOR ASPECT OF ACROMION • DISTALLY – LEVEL OF DELTOID TUBEROSITY • STRAIGHT INCISION OVER INTERVAL BETWEEN DELTOID AND TRICEPS
- 8. • INTERVAL DEVELOPED BLUNTLY BETWEEN LATERAL HEAD OF TRICEPS AND DELTOID • PERIOSTEUM EXPOSED AND INCISED LONGITUDINALLY
- 9. RETRACTION • MEDIALLY- – PERIOSTEUM – LATERAL HEAD OF TRICEPS • LATERALLY- – PERIOSTEUM – DELTOID
- 10. EXTENDED EXPOSURE • PROXIMALLY- – SUBPERIOSTEAL DISSECTION UPTO ORIGIN OF LATERAL HEAD OF TRICEPS – STRUCTURE TO BE PROTECTED • AXILLARY NERVE • POSTERIOR CIRCUMFLEX ARTERY
- 11. • DISTALLY- – INSERTION OF DELTOID PARTIALLY RTELEASED – STRUCTURE TO BE PROTECTED • RADIAL NERVE
- 12. AXILLARY NERVE & POST. CIRCUMFLEX ARTERY RADIAL NERVE AND PROFUNDA BRACHII ARTERY LONG HEAD OF TRICEPS LATERAL HEAD OF TRICEPS DELTOID HUMERUS DELTOID TUBEROSITY
- 13. POSTEROLATERAL APPROACH TO DISTAL HUMERAL SHAFT • MODIFIED LATERAL APPROACH • INTERVAL BETWEEN BRACHIORADIALIS AND TRICEPS • DOESN’T INVOLVE SPLITTING OF TRICEPS
- 15. TECHNIQUE • POSITION – PRONE OR LATERAL PRONE POSITION LATERAL POSITION
- 16. • INCISION- – LONGITUDINAL – 15-18cm LONG – POSTEROLATERAL ASPECT OF ARM
- 18. • EXTENT – DISTALLY MIDWAY BETWEEN • LATERAL EPICONDYLE • TIP OF OLECRANON • 4cm DISTAL TO ELBOW JOINT – PROXIMALLY • 4cm POSTERIOR TO LATERAL INTERMUSCULAR SEPTUM
- 19. • DISSECTION – FROM MID-POINT OF THE WOUND – LATERALLY TILL LATERAL INTERMUSCULAR SEPTUM – TRICEPS FASCIA INCISED LONGITUDINALLY – FASCIA INCISED AT LATERAL EDGE OF ANCONEUS – UPTO 4cm DISTAL TO LATERAL EPICONDYLE
- 20. S
- 21. • RETRACTION – ANCONEUS & FASCIA RETRACTED IN CONTINUITY WITH TRICEPS – POST. ANTEBRACHIAL CUT. NERVE IDENTIFIED & PROTECTED – RADIAL NERVE RETRACTED ANTERIORLY – TRICEPS RETRACTED MEDIALLY
- 23. • CLOSURE – TRICEPS ALLOWED TO FALL INTO IT’S BED – FASCIA CLOSED LOOSELY WITH INTERRUPTED SUTURES
- 24. POSTERIOR APPROACH FOR MIDDLE TWO-THIRDS • HENRY DESCRIBED • SPLITS THE TRICEPS • FOR EXCISION OF TUMORS
- 26. THANK YOU “vihāya kāmānyaḥ sarvānpumāṃścarati niḥspṛhaḥ nirmamo nirahaṅkāraḥ sa śāntimadhigacchati” “That man attains peace who, abandoning all desires, moves about without longing, without the sense of mine and without egoism.”