Posterior approach to the humerus for open reduction and internal fixation of fractures

1. ‫ت‬‫ر‬‫ا‬‫ز‬‫و‬
‫صحت‬
‫عامه‬
‫شفاخانهء‬
‫یر‬‫ز‬‫و‬
‫محمد‬
‫اکبر‬
‫خان‬
‫رح‬
‫تمنت‬‫ر‬‫ديپا‬
‫ا‬
‫و‬
‫توپيدي‬‫ر‬
‫و‬
‫ي‬‫ژ‬‫تراوماتولو‬
‫الرحیم‬ ‫الرحمن‬ ‫هللا‬‫بسم‬
‫داکتر‬
‫وحید‬
‫هللا‬
‫یعقوبي‬
‫اوماتولوژي‬‫ر‬‫ت‬‫و‬‫توپيدی‬‫ر‬‫ا‬ ‫م‬‫ر‬‫چها‬‫سال‬ ‫ترینی‬ ،
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۱۳۹۹

2. Posterior approach to humerus
‫مداخلهء‬
‫خلفي‬
‫عضد‬ ‫عظم‬‫در‬
‫ت‬‫ر‬‫ا‬‫ز‬‫و‬
‫صحت‬
‫عامه‬
‫شفاخانهء‬
‫یر‬‫ز‬‫و‬
‫محمد‬
‫اکبر‬
‫خان‬
‫رح‬
‫تمنت‬‫ر‬‫ديپا‬
‫ا‬
‫و‬
‫توپيدي‬‫ر‬
‫و‬
‫ي‬‫ژ‬‫تراوماتولو‬
‫الرحیم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
‫داکتر‬
‫کلیم‬
‫هللا‬
‫دګ‬‫ر‬‫و‬
،
‫تمنت‬‫ر‬‫ديپا‬
‫اوماتولوژي‬‫ر‬‫ت‬‫و‬‫توپيدی‬‫ر‬‫ا‬
۱۲
/
۱۲
/
۱۳۹۹

3. 1. INTRODUCTION
Indications
Open reduction and internal fixation of humeral shaft fractures
 Often thought to be more cosmetic when compared to the
anterolateral approach
 Provides good exposure to both middle and distal 1/3 humeral
shaft fractures

4. 2. INTERNERVOUS PLANE
There is no internervous plane and thisis a muscle splittingapproach

5. 3. PREPARATION
Anesthesia
• General
• Local
Position
• Pronewitharm onarmboard,abducted45-60degrees
• Lateralwitharm overthetopofthebody
Tourniquet
IntraoperativeImaging

6. 4. APPROACH
Incision
• Incisionfrom8cmdistaltotheacromiontotheolecranonfossa
Superficialdissection
• Fasciashouldbesplitinlinewithincision
Deepdissection
• Splitthefasciabetweenthelongandlateralheadofthetriceps
• Lateralheadisretractedlaterallyandthelongheadmedially
• Radialnervewillbeidentifiedalongwiththeprofundabrachiivesselsinthespiralgroove
• Oftentimesatourniquetisbeneficialuntilthenerveisidentified

7. 4. APPROACH
Extension
• Proximal extension canbe obtained by elevating the lateral head of the triceps
o Allows for radial nerve to be elevated in superior direction
o Limited by branch of radial nerve to medial head of triceps
• Gerwin's modification of this approach allows for great proximal extension than the classic
approach
o This modification retracts the triceps medially after the lateral IM septum is
released, protecting the radial nerve

8. 4. APPROACH
Extension
• Proximal extension canbe obtained by elevating the lateral head of the triceps
o Allows for radial nerve to be elevated in superior direction
o Limited by branch of radial nerve to medial head of triceps
• Gerwin's modification of this approach allows for great proximal extension than the classic
approach
o This modification retracts the triceps medially after the lateral IM septum is
released, protecting the radial nerve

9. 5. DANGERS
Radial nerve
• Nerve crosses posterior aspect of humerus at 20-21 cm proximal to medial
epicondyle and 14-15 cm proximal tolateral epicondyle

10. ‫التوفیق‬ ‫هللا‬ ‫من‬ ‫و‬
Reference:
• https://www.orthobullets.com/approaches/12067/posterior-approach-to-humerus