Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

Abstract

Background: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach.

Methods: We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used.

Results: During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group.

Conclusion: The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves.

Fig. 1

(A) Pre- and (B) postoperative radiographs of a humeral shaft fracture.

Fig. 2

Schematic view of the subbrachial approach showing (A) position of the arm, (B) place of the skin incision, (C) separation of the edges of the brachialis muscle and biceps brachii muscle, (D) separation of the brachialis muscle to the humerus and (E) exposure of the humerus by subperiostal hook placing.

Fig. 3

Intraoperative view of the subbrachial approach showing (A) incision of the skin, (B) surgical approach to intermuscular membrane, (C) separation of the edges of the brachialis and biceps brachii muscles and (D) exposure of the humerus.

Fig. 4

Sagittal section of the upper arm with (A) a view of the direction of the subbrachial approach and (B) a view of the humerus after hook placing. The radial and musculocutaneous nerves are protected by the brachialis muscle.