Anterolateral Approach (Henry’s)

Indications

• Exposure of lateral half of elbow joint
  • Capitellum
  • Proximal third of anterior aspect of radius
• ORIF
  • Capitellum
  • Radial head fractures
  • Biceps avulsion
• Drainage
  • Septic arthritis
• Decompression
  • Arcade of Frohse
  • PIN
• Total elbow replacements

Position

• Supine
• Arm board

Landmarks

• Brachioradialis (mobile wad)
• Biceps tendon
• Anterior elbow crease

Incision

• 15 cm curved longitudinal gentle S shaped incision along anterior aspect of elbow
• Start: 5cm above elbow crease over lateral border of biceps
• Cross elbow crease obliquely
• End: medial border of brachioradialis

Internervous Plane

• Proximally
  • Brachialis
    • Musculocutaneous nerve
  • Brachioradialis
    • Radial nerve
• Distally
  • Brachioradialis
    • Radial nerve
  • Pronator teres
    • Median nerve

Superficial Dissection

• Identify & protect lateral cutaneous nerve of forearm
  • Becomes superficial in distal 5 cm of arm
  • Lateral to biceps tendon
  • Between biceps & brachialis
• Incise fascia on medial side of BR
• Develop interval between BR & brachialis using blunt dissection
• Identify & protect radial nerve at elbow
  • Lives between BR & Brachialis
  • Follow it distally til its 3 branches
    • PIN
    • Superficial radial nerve
    • Branch to ECRB
• Below division of nerve
  • Develop plane between BR & PT
• Ligate recurrent branches of radial artery
• Retract radial artery laterally

Deep Dissection

• Incise anterior capsule between
  • Laterally radial nerve
  • Medially brachialis
• Fully supinate the forearm to expose insertion of supinator
• Incise origin of supinator staying lateral to insertion of biceps

Dangers

• Nerves
  • Radial
  • PIN
  • Lateral cutaneous nerve of forearm
• Vessels
  • Radial artery
  • Recurrent branches of radial artery