Surgical Management
Fixation
Precontoured anatomical plates
Synthes long posterolateral distal humerus plate
Synthes distal humerus plates surgical technique PDF
Approach
Lateral paratricipital approach / Modified Gerwin - identify and protect radial nerve
Medial paratricipital approach - identify and protect ulna nerve
Combined paratricipital approach
Triceps split - interval between long and lateral, then reflect or divide medial head
Lateral paratricipital / Modified Gerwin
Vumedi lateral paratricipital approach video
AO foundation radial window distal humerus
Vumedi tips and tricks to finding radial nerve video
Indication
Holstein Lewis / distal humerus fracture
Approach
Patient lateral with arm over bolster
Mobilise the lateral triceps medially
- reflect from lateral intermuscular septum
Identify and protect the radial nerve
- pierces the lateral intermuscular septum
- 12 - 14 cm proximal to lateral epicondyle
- usually at proximal end of tricipital aponeurosis
- 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
Can use proximal window between long and lateral heads
- slide plate under radial nerve
- fix with screws proximal and distal
Medial para-tricipital approach
Technique
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
Triceps split
Technique
AO foundation triceps split approach
Lateral approach with arm over bolster
- midline incision
- split deep fascia
Identify interval between long and lateral heads of triceps proximally
- split long and lateral heads
- proximal limit: deltoid / axillary nerve / posterior circumflex humeral artery
- distal limit: identify radial nerve / profunda brachii artery in spiral groove
Split common extensor tendon distally
Identify medial head of triceps distal to radial nerve
- divide or reflect medially