Modified Combined Approach for Distal Humerus Shaft Fracture: Anterolateral and Lateral Bimodal Approach

Abstract

BackgroundDue to the anatomical nature of the radial nerve, dissection and attainment of an adequate operative field in mid to distal humerus fracture is dangerous and limited. We devised a combined anterolateral and lateral approach that ensures protection of the radial nerve. This is achieved by performing bimodal dissection of the proximal humerus anteriorly and the distal humerus laterally.MethodsThirty-five consecutive patients were treated using a combined anterolateral and lateral approach for a minimum follow-up period of 24 months. We analyzed time to bony union, time to return to daily work, range of motion, elbow joint function as assessed by the Mayo elbow performance index and complications.ResultsRadiologic bony union was observed at 11.2 weeks (range, 8 to 20 weeks) on average. Four cases of incomplete radial nerve palsy before surgery all recovered. Time to return to work was 10.2 weeks (range, 2 to 32 weeks) on average. The average range of motion of the elbow was 3.3° (range, 0° to 10°) of extension and 135.9° (range, 125° to 145°) of flexion. There were 21 cases of excellent and 13 cases of good or better recovery, comprising over 97.1% on the Mayo elbow performance index. There were no complications of radial nerve palsy, non-union, mal-union, or infection.ConclusionsOur a modified combined anterolateral and lateral approach is a clinically effective surgical method of achieving protection of the radial nerve and securing easy and firm internal fixation.

The outcomes of bridging high-energy humeral shaft fractures using a locking compression plate through an open approach

“…The prognosis and complications in patients who have operative fixation for established nonunion will be different from patients undergoing primary operative fixation. 5,16 Limited-contact dynamic compression plates (LC DCPs) are used commonly for operative fixation of humeral shaft fractures. In comminuted fractures, extensive dissection to achieve anatomical reduction and fixation of comminuted bone fragments leads to inevitable devascularization of these fragments and eventually delayed union or nonunion.…”

“…To avoid such complications, surgical internal fixation is preferred. 5 Recent advances in internal fixation techniques and instrumentation have facilitated the operative treatment of such comminuted fractures, but there is still debate regarding the procedure of choice. 6 Plating or intramedullary nailing is the main surgical option available for the management of closed humeral shaft fractures.…”

Lateral Subcutaneous Locking Compression Plate and Small Incision Reduction for Distal‐third Diaphyseal Humerus Fractures

“…Exploration of the radial nerve is needed, whether through the lateral or posterior approach, and the internal device is placed directly under the nerve. This may lead to adhesion of scarred tissue and fibrosis around the plate and the radial nerve after surgery, increasing the risk of secondary radial nerve injury.…”

“…The patient was placed in a supine position and the fractured arm on a radiolucent board, keeping the limb in abduction and the elbow flexed at 60°‐90°. The small incision surgical approach for fracture reduction is described by Lee et al …”

“…Postoperative malreduction and malrotation of MIPO can result in internal fixation failure or joint function restriction, and is correlated with subsequent long‐term shoulder degeneration. For the treatment of distal‐third diaphyseal humerus fractures, MIPO technology encounters the problem of inadequate fixation space. Moreover, in using the anterior approach of MIPO, the injury of the muscle tissue would affect the elbow and lead to the delay of functional recovery.…”