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[Medial approaches to the distal humerus for fracture fixation]
1Service d'Orthopédie et de Traumatologie (Pr Saillant), GH Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris.
Purpose Of The Study:
We report our experience with the medial and medioposterior approaches to the humeral diaphysis for plate fixation of the proximal humerus.
Material And Methods:
Fifteen patients were treated for shaft fracture (n=13) or nonunion (n=2) of the distal third of the humerus without radial nerve involvement. The medial approach was performed in the supine position and the medioposterior approach in the prone position. Bone healing was achieved in all cases. Three patients experienced sensorial irritation in the territory of the median nerve after the medial approach; one case did not regress. There were no complications with the medioposterior approach.
Discussion:
Dissection of the radial nerve can be avoided with these two approaches which also have a cosmetic advantage. The medioposterior approach appears to be preferable because of the comfortable operative position and the absence of risk for the median nerve. Both approaches are however contraindicated if there is preoperative involvement of the radial nerve.