Posterior approach to humerus

Posterior approach to humerus by Dr. Bipul Borthakur

1. POSTERIOR APPROACH TO HUMERUS DR. BIPUL BORTHAKUR (PROF.) DEPT OF ORTHOPAEDICS, SMCH

2. INTRODUCTION 3 BASIC APPROACHES POSTERIORLY POSTERIOR APPROACH TO THE PROXIMAL HUMNERUS POSTERIO-LATERAL APPROACH TO DISTAL HUMERAL SHAFT POSTERIOR APPROACH FOR MIDDLE TWO-THIRD

3. POSTERIOR APPROACH TO THE PROXIMAL HUMERUS AXILLARY NERVE AND POSTERIOR CIRCUMFLEX HUMERAL ARTERY RADIAL NERVE AND PROFUNDA BRACHII ARTERY LATERAL HEAD OF TRICEPS MEDIAL HEAD OF TRICEPS LONG HEAD OF TRICEPS

4. EXPOSES THE BONE THROUGH THE INTERVAL BETWEEN LATERAL HEAD OF TRICEPS DELTOID 8cm BONE CAN BE EXPOSED APPROX.

5. EXTENT OF THE APPROACH PROXIMALLY- AXILLARY NERVE POSTERIOR CIRCUMFLEX HUMERAL ARTERY DISTALLY- ORIGIN OF TRICEPS FROM LATERAL BORDER OF SPIRAL GROOVE UNDERLYING RADIAL NERVE

6. TECHNIQUE POSITION – LATERAL WITH EXTRIMITY DRAPED FREE AND POSITIONED ACROSS THE CHEST

7. INCISION PROXIMALLY – 5cm DISTAL TO POSTERIOR ASPECT OF ACROMION DISTALLY – LEVEL OF DELTOID TUBEROSITY STRAIGHT INCISION OVER INTERVAL BETWEEN DELTOID AND TRICEPS

8. INTERVAL DEVELOPED BLUNTLY BETWEEN LATERAL HEAD OF TRICEPS AND DELTOID PERIOSTEUM EXPOSED AND INCISED LONGITUDINALLY

9. RETRACTION MEDIALLY- PERIOSTEUM LATERAL HEAD OF TRICEPS LATERALLY- PERIOSTEUM DELTOID

10. EXTENDED EXPOSURE PROXIMALLY- SUBPERIOSTEAL DISSECTION UPTO ORIGIN OF LATERAL HEAD OF TRICEPS STRUCTURE TO BE PROTECTED AXILLARY NERVE POSTERIOR CIRCUMFLEX ARTERY

11. DISTALLY- INSERTION OF DELTOID PARTIALLY RTELEASED STRUCTURE TO BE PROTECTED RADIAL NERVE

12. AXILLARY NERVE & POST. CIRCUMFLEX ARTERY RADIAL NERVE AND PROFUNDA BRACHII ARTERY LONG HEAD OF TRICEPS LATERAL HEAD OF TRICEPS DELTOID HUMERUS DELTOID TUBEROSITY

13. POSTEROLATERAL APPROACH TO DISTAL HUMERAL SHAFT MODIFIED LATERAL APPROACH INTERVAL BETWEEN BRACHIORADIALIS AND TRICEPS DOESN’T INVOLVE SPLITTING OF TRICEPS

14. TECHNIQUE POSITION – PRONE OR LATERAL PRONE POSITION LATERAL POSITION

15. INCISION- LONGITUDINAL 15-18cm LONG POSTEROLATERAL ASPECT OF ARM

16. EXTENT DISTALLY MIDWAY BETWEEN LATERAL EPICONDYLE TIP OF OLECRANON 4cm DISTAL TO ELBOW JOINT PROXIMALLY 4cm POSTERIOR TO LATERAL INTERMUSCULAR SEPTUM

17. DISSECTION FROM MID-POINT OF THE WOUND LATERALLY TILL LATERAL INTERMUSCULAR SEPTUM TRICEPS FASCIA INCISED LONGITUDINALLY FASCIA INCISED AT LATERAL EDGE OF ANCONEUS UPTO 4cm DISTAL TO LATERAL EPICONDYLE

18. S

19. RETRACTION ANCONEUS & FASCIA RETRACTED IN CONTINUITY WITH TRICEPS POST. ANTEBRACHIAL CUT. NERVE IDENTIFIED & PROTECTED RADIAL NERVE RETRACTED ANTERIORLY TRICEPS RETRACTED MEDIALLY

20. CLOSURE TRICEPS ALLOWED TO FALL INTO IT’S BED FASCIA CLOSED LOOSELY WITH INTERRUPTED SUTURES

21. POSTERIOR APPROACH FOR MIDDLE TWO-THIRDS HENRY DESCRIBED SPLITS THE TRICEPS FOR EXCISION OF TUMORS

22. THANK YOU “ vihāya kāmānyaḥ sarvānpumāṃścarati niḥspṛhaḥ nirmamo nirahaṅkāraḥ sa śāntimadhigacchati ” “That man attains peace who, abandoning all desires, moves about without longing, without the sense of mine and without egoism .”