Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus

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Lateral approach

Skin incision

The incision starts over the lateral supracondylar ridge, 5 cm proximal to the elbow joint. It passes distally to the lateral surface of the proximal forearm, posterior to the radial head.
Be careful of the radial nerve, which runs close to the radial head and neck. It divides into its superficial and deep branches at the level of the radial head.


Deep dissection

The deep fascia is incised in line with the skin incision.


This image shows the incision in the deep fascia.


The lateral humeral epicondyle is exposed by developing the interval between the triceps muscle posteriorly, and the brachioradialis and extensor carpi radialis longus anteriorly.
The dissection is continued distally between the extensor carpi ulnaris and the anconeus muscles. The red line marks the site of the capsulotomy, which is shown in the next step.


Opening the joint

The joint capsule is incised longitudinally from the distal part of the lateral humeral epicondyle, over the capitellum and then over the postero-lateral aspect of the radial head.
Alternatively, the capsule can be incised as a proximally based U-shaped flap.


The exposure of the capitellum and the radial head is seen in this photograph.


Further exposure

Subperiosteal reflection of the brachioradialis and extensor carpi radialis longus anteriorly, and the triceps posteriorly will improve joint exposure.

Be careful when placing the anterior retractor as the radial nerve is at risk.

v1.0 2007-06-21