The Modified Anterolateral Approach to the Humerus : Techniques in Orthopaedics (2023)

FAQs

What is anterolateral humerus shaft approach? ›

The anterolateral approach to the humerus provides excellent exposure to the humeral shaft, especially to more proximal aspects. In addition, the approach can be extended both proximally and distally, providing the surgeon a dynamic exposure to the humerus for the treatment of fractures and other pathologies.

The (anterior) deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach. This approach is also highly recommended for revision surgery.

The approach uses a combination of (1) an anterior brachialis muscle splitting approach; (2) an interval exposure of the radial nerve between the brachialis and brachioradialis muscles; and (3) a direct lateral exposure of the lateral epicondyle and the supracondylar ridge, between the brachioradialis/wrist extensor ...

The posteromedial approach allows the surgeon to avoid dissection of the radial nerve, and is an interesting alternative to lateral approaches especially in cases of re-operation or nonunion.

Minimally invasive anterolateral total hip replacement surgery is a specific approach to the hip that minimizes surgical trauma to soft tissues by working between muscle groups with a single small incision. There is no detachment or splitting of muscles that takes place during this procedure.

Anterolateral Approach to the Humerus exposes the distal fourth of the humerus. Its major advantage over the brachialis-splitting anterior approach is that it can be extended both distally and proximally. It's used for: Open reduction and internal fixation of humeral shaft fractures.

Healing Time

The shoulder or proximal humerus treated with surgery takes about 3 months to heal completely. If too much activity is done too early the metal plate can break before bone is healed. Younger patients heal slightly faster and older patients or those with diabetes take slightly longer to heal.

The broken bone will take 3 to 4 months to heal. During this time, you will need to perform exercises to regain range of motion, strength, and return to normal activities. Even if surgery is performed, recovery of full function often takes as long as 18 months.

Healing: This injury normally takes 6-12 weeks to heal. Pain: Take pain killers as prescribed.

The anterolateral (acromial) approach (Mackenzie) can be used for various treatments of proximal humeral fractures. It is especially useful for nailing and osteosynthesis of fractures of the greater tuberosity. It is also recommended for minimally invasive plate osteosynthesis (MIPO).

What is Campbell approach to distal humerus? ›

The triceps-splitting approach [11,12], also known as the Campbell approach, involves a midline incision in the triceps, and divides the triceps into equal medial and lateral halves. The incision continues to the olecranon insertion, and the triceps are peeled subperiosteally to expose the distal humerus.

There are two traditional types of surgical accesses in the treatment of distalthird fractures of the humerus: a lateral approach with supine position of the patient or a posterior approach with prone or lateral position.

In summary, the modified anterolateral approach to the humerus provides excellent exposure for repair of humeral shaft fractures. This exposure encounters the radial nerve in a predictable manner crossing obliquely through the distal portion of the incision and minimizes chances of iatrogenic injury.

The lateral approach allows safe exposure of the distal two thirds of the humerus. It can be extended proximally also to expose the proximal humerus.

The major difference between the two approaches is, unlike lateral (side of the hip) approaches, the anterior approach uses an incision in the front of the hip while the patient is laying on their back. While both options for hip replacement provide some benefits, it's not without its disadvantages.

Femoral nerve palsy is an uncommon but serious complication during the anterolateral approach for total hip arthroplasty. One of the reported reasons for femoral nerve palsy is retractor-induced intraoperative damage after retractor placement on the anterior wall of the acetabulum.

Anterior Approach Precautions

Do not allow surgical leg to externally rotate (turn outwards). Do not cross your legs. Use a pillow between legs when rolling. Sleep on your surgical side when side lying.

Definition. The antero-lateral surface is directed lateralward above, where it is smooth, rounded, and covered by the Deltoideus; forward and lateralward below, where it is slightly concave from above downward, and gives origin to part of the Brachialis.

The anterolateral approach (Watson-Jones) to the proximal femur, through the interval between glutei and tensor fasciae latae provides somewhat limited access to the hip joint along with the lateral proximal femur.

What is anterolateral position? ›

As for anterior lateral or anterolateral , this is equivalent to “toward the front” and “towards the edge” in standard anatomical position. Anterior features are closer to the front of the body while lateral features are closer to the edge of the body.

After your surgery, your arm will be immobilized. You'll need some combination of a splint, cast or sling before you can start using it as you did before your fracture.

With proximal humerus repair surgery, you will be placed in a sling. You need to wear the sling for 6 weeks. It should only be removed for showering and for your exercises. Until you have seen physical therapy, you should come out at least 3 times a day to move your elbow, wrist and fingers.

You can expect some pain and swelling around the cut (incision) the doctor made. This should get better within a few days after your surgery. But it is normal to have some pain for 2 to 3 weeks after surgery and mild pain for up to 6 weeks after surgery.

NO BATHING OR SHOWERING.

Use a face cloth, soap and water ensuring the area is dried thoroughly. Do not try to raise your arm A fractured Humerus can be very mobile.

The Femur is often put at the top of the most painful bones to break. Your Femur is the longest and strongest bone in your body, running from your hip to your knee. Given its importance, it's not surprising that breaking this bone is an incredibly painful experience, especially with the constant weight being put on it.

Infection. Bleeding. Nerve damage. Tissue death due to poor blood supply (avascular necrosis) of the humerus.

Most humerus body fractures can be treated with a conservative approach with a success rate of more than 90% [1].

Showers are not recommended when you have a cast on your arm because you must not get the cast wet. There are products that help protect your cast while in the shower, like this waterproof cast cover, but most doctors recommend taking a bath instead to avoid getting water in your cast.

Keep the elbow of your injured arm tucked into your side and your elbow bent. Hold onto a stick/umbrella/golf club or similar. Use your unaffected arm to push your injured hand outwards. Remember to keep your elbow tucked in.

What are the three syndromes of McKenzie? ›

The McKenzie method describes three syndromes: postural (end-range stress of normal structures), dysfunction (end-range stress of shortened structures possibly due to scarring, fibrosis, or nerve root adhesion), and derangement (anatomical disruption or displacement within the spinal segment).

The McKenzie method isn't for everyone. If you've had back surgery, it's best to avoid this program. You should also avoid it if you have a serious spinal condition, such as a spinal fracture. It also doesn't hurt to check with your healthcare provider before attempting these exercises.

The treatment component of the McKenzie method is contraindicated in patients with serious spinal pathology such as fracture, infection, cancer, or cauda equina syndrome.

This approach involves an osteotomy of the olecranon to give better access to the distal humerus. There are several described patterns of osteotomy. The most commonly used technique is a distally-based chevron osteotomy as this provides greatest access and has inherent rotational stability.

There are 8 technical objectives by which these principles are met: (1) every screw in the distal fragments should pass through a plate; (2) engage a fragment on the opposite side that is also fixed to a plate; (3) as many screws as possible should be placed in the distal fragments; (4) each screw should be as long as ...

Non-operative treatment of PHF usually involves a period of immobilization followed by physiotherapy. Immobilization provides support and pain relief during healing, while physiotherapy aims to restore the function and mobility of the injured arm. In our opinion, PHF should be immobilized in some external rotation.

Bauman's angle is used to determine the degree of displacement and angulation, and the quality of fracture reduction. Carrying angle is the clinical parameter ofvarus-valgus angulation with elbow fully extended and forearm completely supinated.

A distal humerus fracture is a break in the lower end of the upper arm bone (humerus), one of the three bones that come together to form the elbow joint. A fracture in this area can be very painful and make moving the elbow impossible.

Outcomes. Most patients can return to their normal activities within about 6 months, although full healing can take up to 2 years. Recovering strength in your arm often takes longer than might be expected—sometimes up to 6 months or more.

Anterolateral Approach to the Shoulder offers excellent exposure to the acromioclavicular joint and the coracoacromial ligament and supraspinatus tendon, and it's used for: Rotator cuff repair. Repair of the long head of the biceps. Acromioclavicular joint decompression.

What is anterior approach to distal third humerus? ›

An anterolateral approach of the distal humerus is a safe approach for treating distal third humeral shaft fractures. This extensile approach can be used to address more proximal and distal injuries and should be considered an alternative approach for distal third humeral shaft fractures.

Open reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures.

Humerus: The humerus AP radiograph is obtained with the patient standing erect or supine with the humerus aligned to the long axis of the image receptor. The arm needs to be abducted slightly with the supination of the hand for a true AP View. A lateral radiograph of the humerus can be obtained in different ways.

The anterolateral approach is the classic approach for humeral shaft fracture fixation. It allows for excellent fracture exposure and fixation. In the medial approach, the brachial vessels and the median nerve run in a relatively superficial location, making them easy to explore.

The shoulder or proximal humerus treated with surgery takes about 3 months to heal completely. If too much activity is done too early the metal plate can break before bone is healed. Younger patients heal slightly faster and older patients or those with diabetes take slightly longer to heal.

For a fractured proximal humerus, a sling may be needed for up to two weeks. For a fractured scapula, doctors usually recommend wearing a sling until you can move the shoulder without significant pain—anywhere from two to four weeks.

Expect swelling and bruising for a few weeks following the surgery. This is due to the trauma from the fracture and from the surgery. The swelling and bruising may go below the elbow into the wrist and hand or into the front of the chest. Take a stool softener or laxative if needed.

In anterolateral approach group, a curved incision began 5 cm above the elbow flexion crease in the supinated forearm, and followed the lateral border of the biceps distally, but curves laterally at the elbow joint level to avoid crossing a flexion crease at 90°.

The anterolateral surgical exposure for mini-incision hip replacement described in this article is one that allows THR to be done through a very small incision. This skin incision leads to an intermuscular exposure of the hip intended to cause minimal muscle damage and to facilitate rapid rehabilitation.

This incision is centered at the ankle joint, parallel to the fourth metatarsal distally, and parallel to and between the tibia and fibula proximally. Dissection through the skin and subcutaneous tissues should proceed sharply with maintenance of full thickness skin flaps.

What is an anterior lateral approach? ›

The anterolateral approach (Watson-Jones) to the proximal femur, through the interval between glutei and tensor fasciae latae provides somewhat limited access to the hip joint along with the lateral proximal femur.

Do not try to raise your arm A fractured Humerus can be very mobile. You may feel or hear the bone moving; this is not unusual but by allowing your arm to relax from the shoulder and hang loose may reduce or even prevent this from happening.

Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is often performed to allow earlier mobility.

It takes approximately 12 weeks for bony healing in most cases. Some fractures will benefit from early fixation.

The best hip replacement operation out there, is through the anterior approach. Anterior - meaning from the front of your hip. Most of the country traditionally goes from the posterior approach. The posterior approach works, but post-operative dislocations are higher than the anterior approach.

The anterior approach to hip replacement tends to provide the surgeon with a more limited view of the hip joint during surgery, making the surgery technically challenging, especially for less experienced surgeons. The posterior and direct lateral approaches provide the surgeon with a better view of the hip joint.

The posterior approach to total hip replacement is the most commonly used method and allows the surgeon excellent visibility of the joint, more precise placement of implants and is minimally invasive.

Anterolateral impingement syndrome of the ankle is caused by entrapment of the hypertrophic soft tissue in the lateral gutter. The impingement process begins when an inversion sprain tears the anterior talofibular, and/or the calcaneofibular ligament.

Anterolateral Impingement: May be caused by inversion ankle sprains causing inflammation and scar formation or reactive synovitis. May also be due to forced plantarflexion and supination which can tear anterolateral capsular tissues.

Pain at the front and outside aspect of the ankle joint (“anterolateral” region) is the main feature of anterolateral ankle impingement. This pain is often precipitated when the leg is bent forward over the ankle (dorsiflexed). There may be a history of a twisting ankle injury in the past.