Posterolateral Approach to Radial Head

Indications

  • ORIF
  • Excision
  • Replacement

Position

  • Supine
  • Arm positioned over chest
  • Pronate forearm

Landmarks

  • Lateral humeral epicondyle
  • Radial head
    • 2.5 cm distal to lateral epicondyle
  • Olecranon

Incision

  • 5 cm longitudinal incision
  • Start: Posterior surface of lateral humeral epicondyle
  • Continued downward & medially
  • End: towards the posterior border of ulnar

Internervous Plane

  • Anconeus — radial nerve
  • ECU — PIN

Superficial Dissection

  • Deepen skin incision through fat & deep fascia
  • Identify the plane between anconeus & ECU
  • Develop it with blunt dissection & detach part of the superior origin of anconeus from the lateral humeral epicondyle

Deep Dissection

  • Fully Pronate forearm to protect the PIN
  • Incise capsule longitudinally
    • Capitellum
    • Radial head
    • Annular ligament
  • To expose capitellum
    • Cut down onto lateral supracondylar ridge
    • Elevate subperiosteally

Dangers

  • PIN