title: Modified combined approach for distal humerus shaft fracture: anterolateral and lateral bimodal approach.
abstract: BACKGROUND
  Due to the anatomical nature of the radial nerve, dissection and attainment of an adequate operative field in mid to distal humerus fracture is dangerous and limited. We devised a combined anterolateral and lateral approach that ensures protection of the radial nerve. This is achieved by performing bimodal dissection of the proximal humerus anteriorly and the distal humerus laterally.
  
  
  METHODS
  Thirty-five consecutive patients were treated using a combined anterolateral and lateral approach for a minimum follow-up period of 24 months. We analyzed time to bony union, time to return to daily work, range of motion, elbow joint function as assessed by the Mayo elbow performance index and complications.
  
  
  RESULTS
  Radiologic bony union was observed at 11.2 weeks (range, 8 to 20 weeks) on average. Four cases of incomplete radial nerve palsy before surgery all recovered. Time to return to work was 10.2 weeks (range, 2 to 32 weeks) on average. The average range of motion of the elbow was 3.3° (range, 0° to 10°) of extension and 135.9° (range, 125° to 145°) of flexion. There were 21 cases of excellent and 13 cases of good or better recovery, comprising over 97.1% on the Mayo elbow performance index. There were no complications of radial nerve palsy, non-union, mal-union, or infection.
  
  
  CONCLUSIONS
  Our a modified combined anterolateral and lateral approach is a clinically effective surgical method of achieving protection of the radial nerve and securing easy and firm internal fixation.
authors.affiliation: Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea. TJLEE@inha.ac.kr
authors.forename: Tong Joo
authors.initials: TJ
authors.lastname: Lee
authors.forename: Dae Gyu
authors.initials: DG
authors.lastname: Kwon
authors.forename: Suk In
authors.initials: SI
authors.lastname: Na
authors.forename: Seung Do
authors.initials: SD
authors.lastname: Cha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D062707:Return to Work; D016896:Treatment Outcome
keywords: Distal shaft fracture; Humerus; Plate fixation; Radial nerve; Surgical approach