Anterolateral approaches are a viable and safe alternative for proximal humerus osteosynthesis with locking plate. Upper extremity surgeon university of mississippi medical center, usa. Surgical exposures of the humerus the neurovascular and muscular anatomy about the humerus precludes the use of a truly safe fully extensile approach. Ppt fractures of the humeral shaft powerpoint presentation. Anterolateral surface of shaft of humerus definition of. The anterolateral intertubercular approach to the shoulder. The medial approach does not require a prebent plate and creates a large operative exposure. Proximal humerus fractures orif through an anterolateral. Principles of orif for proximal humerus fractures vumedi. Mipohumerus, proximalanterolateral approach surgery. Trauma vivas for the frcs pdf free download direct link.
Modified combined approach for distal humerus shaft fracture. Orif proximal humerus fracture with anatomic gt plating system courtesy. Humerus anterolateral approach approaches anterolateral approach to distal humerus 1022012 4179 views topic comments 3 please login to add comment. Orif of a valgus three part proximal humerus fracture through the anterolateral acromial approach, using the raphe between the anterior and middle heads of the deltoid and identification of the axillary nerve. The value of this exposure is that it can be extended through the deltopectoral interval to expose the proximal humerus and extension distally allows adequate access even to the anterior aspect of the elbow joint.
The lateral approach is used for the distal quarter of the humerus. Crosssectional level of the distal humeral shaft and anatomic course of radial. The anterior and anterolateral approaches to the humerus describe splitting brachialis longitudinally, assuming its fibres run. Modified anterolateral approach hip replacement and recovery. The anterolateral approach to the proximal humerus for nonunions and delayed unions. Anterolateral approach to the distal humerus flashcards.
Twentythree patients were evaluated clinically at a minimum followup of 1 year average, 28 months by clinical examination for range of motion and. We present our technique for this approach with special focus on performing a submeniscal arthrotomy, placing a femoral distractor and elevation of the joint surface. Your browser does not currently recognize any of the video formats available. Modified anterolateral approach for internal fixation of. Orif of the proximal humerus through an anterolateral. Extended anterolateral approach cambridge orthopaedics. Anterior approach to the humeral shaft blair on vimeo.
The anterior motor branch of the axillary nerve crosses the humerus horizontally about 6 cm distal to the lateral border of the acromion. Using this minimally invasive technique and minimizing soft tissue injury, anterolateral hip replacement in mexico streamlines the process for hip replacement patients. Presented in this video are surgical techniques of an anterolateral approach to the humerus, illustrated in the case of a humeral shaft fracture treated with open. The most common and useful approach to the anterior aspect of the humerus is. Anterolateral approach p 600 medial approach p 600 dorsal approach henry approach p 600 reduction techniques and tools p 600602 choice of. Describe the dissection for the anterolateral approach to the distal humerus incise the deep fascia and retract the biceps medially revealing the brachialis and brachioradialis incise the muscular fascia. Working around a spiraling radial nerve at the posterior midshaft requires either a transmuscular dissection or a tricepsavoiding paramuscular technique. Internal fixation for coronal shear fracture of the distal. The goal of our study was, therefore, to report the outcomes of dual small 3. Modified combined approach for distal humerus shaft. Anterolateral approach results in less pain, quicker recovery and faster return to an active lifestyle. The medial approach to the humerus had equivalent outcomes to anterolateral fixation.
Posteromedial approach to the distal humerus for fracture. This video has been presented as a scientific exhibit at the 2016 aaos annual meeting. Plate fixation is the gold standard for diaphyseal fracture management, and the anterolateral approach is widely used by reconstructive surgeons. Anterolateral approach regarding the proximal humerus level 1 and 2. Orif through an anterolateral acromial approach michael gardner, md by orthopaedic trauma association on vimeo. Upgrade to view premium videos upgrade to view premium videos. This video demonstrates the anterolateral and direct anterior approach to the humeral shaft for fracture reduction and fixation. Fractures of the humeral shaft are relatively common and can occur in any a variety of age groups, and due to a variety of mechanisms of injury. This video highlights a clinical case where a midshaft humerus fracture was diagnosed and treated with open reduction internal fixation using an 8hole. Anatomical landmarks for the anterolateral approach are.
Multiple parameters were measured regarding the axillary nerve. Surgical approach and axillary nerve identification. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Humerus anterolateral approach surgery video general. The anterior motor branch of the axillary nerve crosses the humerus horizontally. It is known that shoulder surgery may cause iatrogenic injury to the axillary nerve as a serious complication, but there is little evidence to indicate whether the axillary nerve is at risk of injury during an anterolateral acromial approach for minimallyinvasive plate osteosynthesis mipo of proximal humerus fractures. The anterolateral approach to the proximal humerus. Thus, it provides better exposure of the greater tuberosity when. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. Jan 25, 2012 minimally invasive plate osteosynthesis of proximal humerus fractures via an anterolateral delta split approach.
Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. In addition, the approach can be extended both proximally and distally. The anterolateral approach to the tibia has been popularized for management of tibial pilon fractures. Over a 4year period, 52 patients with acute displaced fractures of the proximal humerus were treated with the anterolateral acromial approach and either a locking plate or an intramedullary nail. Presented in this video are surgical techniques of an anterolateral approach to the humerus, illustrated in the case of a humeral shaft fracture treated with open reduction and internal fixation. It is an available choice for humeral midshaft fracture fixation in cases where there is no need to expose. The incision follows a line extending from the interval distally between biceps and the mobile wad brachioradialis and the wrist extensors to the deltopectoral interval proximally, following the lateral edge of biceps and the anterior edge of the deltoid. Alright, now in this part of the article, you will be able to access the free pdf download of trauma vivas for the frcs pdf using our direct links mentioned. Anterolateral approach to distal humerus approaches. This video highlights a clinical case where a midshaft humerus fracture was diagnosed and treated with open reduction internal fixation using an 8hole 4.
The anterolateral and posterior approach are both adequate for midshaft and distal third fractures. Traditional approaches to the humerus such as the anterior or anterolateral approach ala assume homogenous brachialis muscle morphology with fibres that run parallel to the. The patient is placed on her side and a straight incision of about 10 centimetres is made down the thigh centred on the greater trochanter. Ota video library surgical technique anterolateral. The purpose of our study was to explore a direct anterolateral, less invasive approach to the proximal humerus. Learn about the distal humerus lateral approach, an online 3d video based course, accredited by the royal college of surgeons of england. Crosssectional anatomy of the distal humeral shaft. The aim of this study is to explore the management and outcomes of humeral midshaft fractures fixed through a medial incision. Aug 20, 20 an anterolateral approach is used easily and safely in most proximal and middle humerus fractures, but in the distal humerus fracture, it is difficult to obtain sufficient space for fixation. The incision follows a line extending from the interval distally between biceps and. A quantitative comparison of the deltopectoral approach and the anterolateral acromial approach.
Approach the standard surgical approach for internal fixation of proximal humerus fractures is the interval between the deltoid and pectoral muscles proximally. Additional, we demonstrate the use of a verbrugge to achieve axial compression across the fracture plane. Extensive dissection anteriorly may further compromise humeral head blood supply see, anterior circumflex humeral artery, humeral head blood supply. However, the outcomes of humeral shaft fracture fixation using a medial approach are rarely reported. Proximal humerus fractures orif through an anterolateral acromial approach september 05, 20 contributors. Anterolateral surface of shaft of humerus information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. Anterolateral approach to the humerus m1566 extended lateral approach to the humerus m7. Humerus shaft fracture orif with anterolateral approach. May 03, 2009 autoplay when autoplay is enabled, a suggested video will automatically play next.
The value of this exposure is that it can be extended through the. Therefore the anterolateral approach is superior to the lateral or posterior approach for coronal shear fracture of the distal end of the humerus. Plate fixation of proximal humerus fractures using the. A novel extensile approach is described using a neuromuscular bridge to protect the radial nerve, thus enabling safe distal extension of the anterolateral humerus approach. Multiloc proximal humeral nail technique guide synthes 11 approach 2 approach perform an anterolateral approach. Choosing surgical approaches to proximal humerus fractures duration. Tibial plafond fracture orif with anterolateral approach and plate fixation ankle and hindfoot ankle simple bimalleolar fracture orif with tubular plate and cannulated screw of medial malleol. The humerus articulates with the scapula proximally at the glenohumeral joint so it participates in the movements of the shoulder.
Surgical technique anterolateral approach to the humerus. Do you want to use the redesigned ao sr like an app. Longitudinal incision up to 5 cm is made from the midportion of the lateral. The extended anterolateral acromial approach allows minimally. Humerus anterolateral approach approaches anterolateral approach to distal humerus 1022012 4179 views. Begin the incision at the anterolateral tip of the acromion and carry it.
Treatment of middle third humeral shaft fractures with. The course of the nerve and its intimate relationship to the humerus place it. This approach offers the benefit of improved soft tissue coverage and the potential. Many fractures of the tibial plateau can be treated with an anterolateral approach to the proximal tibia. The deltopectoral approach to the shoulder requires extensive soft tissue dissection and muscle retraction to gain adequate exposure of the lateral aspect of the humerus. Twenty cadaver shoulders were dissected using the extended anterolateral acromial approach through the anterior deltoid raphe.
The anterolateral approach to the proximal humerus for. Head split and closed irreducible dislocation type fractures, fractures with primary neurovascular impairment, and fractures in children with open growth plate. Jan 28, 2016 a novel extensile approach is described using a neuromuscular bridge to protect the radial nerve, thus enabling safe distal extension of the anterolateral humerus approach. Materials and methods this is a prospective study done in sri ramachandra medical college and research. It is an available choice for humeral midshaft fracture fixation in cases where there is no need to. The most common and useful approach to the anterior aspect of the humerus is through the anterolateral interval. Orthopedic trauma incl pediatrics your digital gateway to expertise, education, and innovation. The purpose of this study was to objectively quantify the surface area of the humerus exposed. Lateral approach gives good exposure of entire shaft, but is less familiar. Incision should end approximately 5 cm short of elbow flexion crease lateral antebrachial cutaneous nerve at risk superficial dissection. The authors present a case series of 7 patients who required an extensile humeral exposure.
The anterolateral approach to proximal humerus fractures is performed between the anterior and middle portions of the deltoid. The authors propose an original route of approach to the shoulder that allows direct access to this articulation. This approach allows only exposure up to the proximal portion of the olecranon fossa of the humerus which means that the lateral supracondyle of the. Anterolateral approach to hip replacement surgery mexico. Make a curved incision from the tip of the coracoid process distally in line with deltopectoral groove along the lateral aspect of the humerus. Supine extensile approach to the anterolateral humerus. The bony landmarks of the corocoid anteriorly, the ac jointanterior tip of the acromion laterally and the spine of the scapula posteriorly are identified. The posterior tricepssplitting approach exposed an average of 15. Lateral approach to distal humerus approaches orthobullets. Presented in this video are surgical techniques of an anterolateral approach to the humerus, illustrated in the case of a humeral shaft fracture treated with op. However, in vivo studies about dual plate fixation for humeral shaft fractures are limited. Humeral shaft fractures, plate osteosynthesis, anterolateral approach. In the anterolateral approach, the lateral aspect of the humerus is uneven, often leading to medial gapping during fixation fig.
It is an available choice for humeral midshaft fracture fixation in cases where there is no need to expose the radial nerve. One patient in the medial group and two patients in the anterolateral group had radial nerve dysfunction that. Hip anterolateral approach watsonjones hip medial approach hip direct lateral approach hardinge, transgluteal. The anterolateral acromial approach for fractures of the. Mipo of proximal humerus fractures through an anterolateral. Minimal invasive plate osteosynthesis mipo technique. Debate exists over the optimal approach for addressing fractures of the proximal humerus. In this approach, the triceps muscle is retracted medially to expose the. Medial approach to treat humeral midshaft fractures. Up next humeral shaft fracture open plating strategies duration. Gardner, md 4 years ago this video demonstrates orif of a proximal humerus fracture through the anterolateral acromial. This video demonstrates the anterolateral acromial. This video highlights a clinical case where a midshaft humerus fracture was diagnosed and treated with open reduction internal fixation using an 8.
Anteromedial plating of humerusan easier and effective. Mar 17, 2016 plate fixation is the gold standard for diaphyseal fracture management, and the anterolateral approach is widely used by reconstructive surgeons. Depending on the fracture and its location, a smaller section might be used. All proximal humerus fractures classified as 11a, 11b12 b3, and 11c12 c3 according to the aoota system. Phieffer, md ohio state university wexner medical center october 12, 20 1. The modified anterolateral approach is the most commonly used approach in contemporary hip replacement surgery. It consists of a proximal end, a shaft and a distal end, all which contain important anatomical landmarks.
The proximal humeral locking plate phlp is a recently developed fixedangle implant that is an option for. Crosssectional level of the distal humeral shaft and anatomic course of radial nerve. Pdf medial approach to treat humeral midshaft fractures. The extended anterolateral acromial approach allows. Proximal extension possible via deltopectoral interval. In the anterolateral approach, herbert screws, which compress the fracture site from an anterior to posterior direction on the distal humerus, appear to be sufficiently strong to maintain the. The modified anterolateral approach to the humerus. Twenty cadaver shoulders were dissected using the extended anterolateral acromial. This video presents the surgical technique of the anterolateral approach to the hip performed in the supine position. Traditional approaches to the humerus such as the anterior or anterolateral approach ala assume homogenous brachialis muscle morphology with fibres that run parallel to the humeral shaft. The anterolateral approach to the humerus provides excellent exposure to the humeral shaft, especially to more proximal aspects.
Less invasive osteosynthesis approach in proximal humerus fracture 19 osteosynthesis mipo, which offer minimal soft tissue damage and rapid and improved healing of the fracture 7,8. Anterior approach to the humerus orthopaedicsone articles. In a previous study, we described a minimally invasive anterolateral approach for complex proximal humerus fractures. Anterolateral approach and many more surgical approaches described step by step with text and illustrations. Surgical technique for open reductioninternal fixation of an.
However, the medial approach is not suitable to proximal or distal humerus fractures. Anterolateral approach to distal humerus approaches orthobullets. Thanks to this route, complex fractures of the proximal end of the humerus can be treated by ostosynthesis or prosthesis, and shoulder arthroses, whether centered or not by prosthesis. The modified anterolateral approach to the humerus angela. Superficially, the deltoid is split between the anterior and middle fibers in line with the skin incision video 1. This approach was previously restricted due to the position of the axillary nerve for its use for only up to 35 cm distal to the acromion.