Maintains ability to rotate humerus — extremely useful in being able to control a prosthesis
Humeral condyles allow for easier prosthetic fitting
Can add distal humerus osteotomy — 45deg anterior angulation
- Allows for prosthesis fitting and reduces need for a shoulder harness
Better for paediatrics
- Prevents bony overgrowth in paediatrics seen with transhumeral amputations and allows for normal distal humeral growth
Technique
- Equal anterior & posterior skin flaps
- Begin proximally at level of epicondyles & extend posteriorly to 2.5cm distal to olecranon & anteriorly just distal to insertion of biceps tendon
- Start medially & divide:
- Lacertus fibrosus
- Free flexor origin
- Expose NV bundle medial to biceps
- Proximal to joint isolate/ligate/divide brachial artery
- Divide median nerve sharply so it retracts at least 2.5cm proximal to joint
- Divide ulnar nerve
- Release biceps & brachialis distally
- Divide radial nerve
- Identify radial nerve between brachialis & brachioradialis & divide sharply
- Posteriorly 6.3cm distal to joint
- Divide extensors transversely & reflect proximally
- Divide triceps tendon near tip of olecranon,
- Divide anterior capsule & remove forearm
- Bring triceps tendon anteriorly & suture to tendons of biceps & brachialis,
- Bring flap of extensors left attached to lateral epicondyle medially
- Suture to remnants of flexor mass at medial epicondyle
- Ensure all bony prominences & tendons covered
- Insert drain deep to fascia
- Close skin edges with interrupted nonabsorbable sutures
Author Contributions
Page written by Dr James Drummond