- Anterolateral approach
The complete incision is illustrated here. Depending on the fracture and its location, a smaller section might be used.
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.
Minimize any detachment of subcutaneous tissue from the muscular fascia.
Incise the fascia carefully between biceps/brachialis and the mobile wad, and extend proximally.
Look for the lateral cutaneous nerve of the forearm crossing distally. The radial nerve is deeper. It should be identified in the interval between biceps and the mobile wad, and followed proximally as the incision is developed.
Proximally, look for the cephalic vein in deltopectoral interval. If it is retracted with the deltoid, muscular tributaries are less likely to be torn.
Retract the biceps and brachialis medially, and the mobile wad laterally in order to identify the radial nerve.
Extend the dissection proximally, as needed, to the anterior border of the deltoid and along the deltopectoral interval.
Distally, the anterior humerus has been exposed to the elbow joint, between the mobile wad and brachialis.
Mobilize the radial nerve, as needed, to access the bone. Follow the nerve to the point where it passes through the lateral intermuscular septum.
Partially release the deltoid insertion anteriorly, if necessary, and retract laterally to access the proximal humerus.
Alternatively dissect bluntly under the central deltoid insertion to allow for plate placement.
Leave as much muscle attached to bone as possible in order to preserve vascularity.