Anterolateral approach to the distal humerus

Indications

• Distal humerus ORIF
• Exploration of radial nerve

Position

• Supine
• Arm board

Landmarks

• Biceps
• Anterior flexion crease of elbow

Incision

• Curved longitudinal incision along lateral border of biceps
• Start: 10 cm above elbow crease
• End: just above elbow crease

Internervous Plane

• Brachialis 
  • Radial nerve
• Brachioradialis
  • Radial nerve

Superficial Dissection

• Beware lateral cutaneous nerve of forearm
• Identify lateral border of biceps & retract medially
• Develop the plane between brachialis & brachioradialis
• Identify the radial nerve near the elbow & follow it up to where it pierces the lateral intermuscular septum
• Isolate & retract radial nerve laterally with vascular loops

Deep Dissection

• Incise along the lateral border of brachialis down to periosteum & bone

Dangers

• Nerves
  • Lateral cutaneous nerve of forearm
  • Radial nerve