Posterior Approach to Humerus

Indications

• ORIF
• Osteomyelitis
• Exploration of radial nerve

Position

• Lateral
• Axillary roll
• Arm over radiolucent L bar

Landmarks

• Acromion
• Olecranon fossa

Incision

• Longitudinal midline incision
• Start: 8cm below acromion
• End: olecranon fossa

Internervous Plane

• Triceps splitting approach
  • Medial head of triceps supplied by radial nerve
  • Long head supplied by branch of axillary nerve

Superficial Dissection

• Deep fascia
• Triceps
  • Superficial
    • Lateral head
      • Lateral lip of spiral groove (above spiral groove)
    • Long head
      • Infraglenoid tubercle
  • Deep
    • Medial head
      • Below spiral groove
• Ligate blood vessels

Deep Dissection

• Incise medial head in midline
• Subperiosteal dissection

Dangers

• Nerve
  • Radial nerve
  • Ulnar nerve
• Vessels
  • Profunda brachii artery