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Beitragstitel Extended anterior approach to the humerus shaft - Cadaveric Study
  1. Philipp Birchler Kantonsspital St. Gallen KSSG Vortragender
  2. Karl Grob Kantonsspital St. Gallen
  3. Kay-Bernd Lanner
Präsentationsform Poster
  • A01 - Schulter/Ellbogen
Abstract Introduction:
Selection of surgical approach for humeral shaft fracture depends on fracture location. Extended anterior approach to the humerus is difficult because neurovascular structures converge on the anterolateral aspect of the elbow. Many surgeons are unfamiliar with the specific anatomical features of this region. The purpose of the present study was to clarify the anatomy of the anterior approach to the entire humerus and to investigate how far distally an anterior plate can be placed safely without jeopardizing neurovascular structures.

An extended anterior approach was performed on 30 cadaveric upper arms. A plate was adjusted helically to the entire humerus from the greater tuberosity to the coronoid fossa. Distally, the plate was placed underneath the brachialis muscle. Thereby, brachialis splitting was limited to the plate holes by blunt dissection. At determined levels, distances from the plate edges to adjacent neurovascular structures at risk (musculocutaneus nerve (MCN), lateral antebrachial cutaneous nerve (LACN), radial nerve, median nerve and brachial artery) were measured. The innervation pattern of the brachialis muscle was revealed and the potential risk of its denervation during surgery was analysed.

Safe anterior plating of the entire humerus without damage to neurovascular structures occurred in all 30 specimens. Where the radial nerve pierced the lateral intermuscular septum its distance to the plate was >1.7cm. On the level of the coronoid fossa safe plate distances were: ≥1.1cm for the radial nerve, ≥1.4cm for the LACN, and ≥1.7cm for the median nerve and brachial artery. The brachialis muscle showed in 90% a dual innervation by the MCN and the radial nerve. The brachialis muscle regularly consisted of 3-4 intramuscular crossing neurovascular pedicles. The most proximal pedicle was always heavy-calibred and constantly found in all specimens.

Extended anterior approach to the entire humerus can be safely performed. Identification of the brachialis muscle crossing neurovascular pedicels may prevent damage to muscle innervation. Since the radial nerve runs at a safe distance to the helically shaped plate, identification is not compulsory. Anterior plate osteosynthesis of the humerus represents an advantageous alternative to the posterior or two incision approaches to the humerus.
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