Master Tech Ortho Surgery Elbow CH1
PART I Exposures
CHAPTER 1A: SURGICAL EXPOSURES OF THE HUMERUS ANTEROLATERAL EXPOSURE OF THE HUMERUS Introduction The most common and useful approach to the anterior aspect of the humerus is through the antero- lateral interval. The value of this exposure is that it can be extended proximally through the delto- pectoral interval to expose the proximal humerus and distally allows adequate access even to the anterior aspect of the elbow joint. Indications Fractures of the proximal and midhumeral shaft, malignancies, revision humeral component total shoulder, and total elbow arthroplasty. For the elbow, salvage revision of very proximal pathology requires use of this exposure as an adjunct to that of the elbow. Position The patient is placed supine with the arm across the chest or in the barber chair semireclined position. Note: Care is taken to assure the primary elbow exposure is not compromised by the initial patient positioning. Landmarks The deltopectoral groove proximally, the lateral margin of the biceps and the mobile wad, the exten- sor muscle mass, distally. Skin Incision ●● The limited midportion of the skin incision is from the anterior–inferior aspect of the deltoid’s attachment on the humerus to the lateral epicondyle (Fig. 1A-1). ●● This may be expanded proximally to include the distal portion of the deltopectoral groove (Fig. 1A-2).
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