• dorsal approach to radius
• plane of dissection
• prox- ECRB and EDC
• distal- ECRB and EPL
• incision- anterior to lateral epicondyle of humeus until just distal to Lister's tubercle
• Dangers- PIN (usually 2/2 retraction)
• avoid by IDing PIN within supinator

• volar approach to radius
• plane of dissection
• prox- brachioradialis and pronator teres
• distal- brachioradialis and FCR
• incision- lateral to biceps tendon to the radial styloid process
• dangers
• PIN
• superficial radial N. (under brachioradialis)
• radial A. (under brachioradialis)

• plane of disection- ECU (PIN) and FCU (ulnar N.)
• incision- longitudinally over subQ border of ulna
• dangers
• ulnar N. (on top of FDP btw two heads of FCU)
• ulnar A. (radial to N.)

deltopectoral approach- indications, dissection plane, dangers

• indiciations
• prox humerus fx
• TSA
• long head of biceps injury
• reconstruction of recurrent dislocations
• septic glenohumeral joint
• internervous plane
• btw deltoid and pectoralis major
• incision- follow deltopectoral groove (10-15 cm)
• dangers
• cephalic vein
• musculocutaneous N.
• axillary N. (esp. when release subscapularis or incision at lat dorsi or teres major tendon)

• no true intramuscular plaine- split deltoid in line with fibers
• incision made in line with fibers going distally no further than 5 cm from tip of acromion
• perform bursectomy

• intramuscular plane- infraspinatous and teres minor
• Positionining- lateral decubitus position
• incision
  • incision made along scapular spine, extending to lateral border of acromion
  • origin of deltoid is released from scapular spine
  • dissect plane between deltoid and infraspinatous, retract deltoid distally
  • develop interval between infraspinatous (superior) and teres minor (inferior), retract superior and inferior, respectively
• Dangers
  • suprascapular N (passes around base of scapular spine)
  • axillary N (its inferior to teres minor)

• intramuscular plane
  • proximal- deltoid and pect major
  • distal- medial and lateral brachialis
• position- supine, arm board, abducted to 60 degrees
• incision- curved incision from tip of corocoid process to 5 cm proximal to elbow flexion crease
• superficial dissection
  • identify cephalic vein
  • develop plane btw deltoid and pect major
  • incision deep fascia in line with skin incision
  • identify interval between biceps brachi and brachaialis
• deep dissection
  • incision periosteum lateral to pect major tendon, stay lateral to long head of biceps (must now ligate anterior circumflex humeral A.)
  • splint brachialis fibers longitudinally
• DANGERS
  • anterior circumflex humeral A 
  • axillary N
  • radial N

• incision 8 cm distal to acromion to olecranon fossa
• split fascia and between long and lateral head of triceps
• ID radial nerve with profunda brachii
• elevate lateral head of tricpes (it will protect radial nerve)
• Gerwin's modification of this approach allows for great proximal extension than the classic approach
  • this modification retracts the triceps medially after the lateral IM septum is released, protecting the radial nerve
• DANGER- radial nerve

• indication- extra-articular fx or with simple articular split
• medial side
  • identify ulnar nerve and dissect it 15cm proximal to elbow joint proximally, and distally to first motor branch to FCU
  • elevate triceps from posterior aspect of humerus on medial side and free it from medial intermuscular septum
  • posterior band of MCL is elevated and posterior joint capsule entered to visualize trochlea
    
    
• lateral side
  • identify radial nerve proper proximally if fracture is distal
    • if fracture is distal and does not require long plates, proper radial nerve does not need to be exposed
  • elevate remainder of tricep from posterior aspect of humerus
  • anconeus may be divided or dissected on lateral side to improve exposure

• indications- ORIF lateral epicondyle, treatment of tennis elbow 
• intramuscular plane- triceps and brachioradialis 
• position- supine, arm across chest
• superficial dissection
  • identify and cut down in btw plane of tricpes and brachioradialis
• deep dissection
  • extend the triceps and common extensor origin
• dangers- radial N (if extend incision proximally)

• intramuscular plane- brachioradialis and brachialis
• incision- curved incison over lateral border of biceps
• superficial dissection
  • ID lateral border of biceps and retract medial (protects LABC), thus revealing brachialis and brachioradialis
• deep dissection
  • incise fascia between brachialis and brachioradialis (ID radial N in btw, trace until pierces intramuscular septum and protect it)
  • biceps and brachioradialis are retracted medially while brachialis is retracted laterally
• DANGERS- LABC, radial N. 

• indications- ORIF distal humerus (as well as non-unions)
• no plane (split extensor mechanism)
• Description
  • incision begins 5 cm proximal to olecranon midline, curve laterally around olecranon, then curve medially about ulna
  • identify ulnar N, protect, and split triceps
• dangers
  • ulnar N (2 cm proximal to medial epicondyle)
  • median N and radial A (runs togethter) (flex elbow to protect)
  • radial N (at radial border of humerus near distal 1/3 junction)

• indications
  • ORIF of the ulnar coronoid process
  • ORIF of the medial humeral condyle and epicondyle
  • debridement and reattachment of common flexor wad for medial epicondylitis
• planes
  • superficial- brachialis and triceps
  • deep- brachialis and pronator teres
• Description- curved incision 8 to 10 cm about the medial aspect of elbow
• Dangers
  • ulnar N.
  • median N. (with aggressive traction)