Lateral approach to the dog humeral shaft

A lateral approach is used for mid-shaft humeral fractures.

The lateral approach can expose the humerus from the greater tubercle to the humeral condyle.

This approach can be used for all types of fixations.

The lateral approach can be used for an open or "open-but-do-not-touch" approach, allowing visualization and reduction.

Note: A medial approach may be preferred for distal fractures in dogs.

The key landmarks to be identified are:

• Greater tubercle (proximal landmark)
• Lateral epicondyle (distal landmark)

Note: It is essential to protect the radial nerve throughout this approach.

This approach is usually performed with the patient placed in lateral recumbency with the injured leg up.

If combining the lateral approach with a medial approach, the patient is placed in dorsal recumbency.

The skin incision follows the craniolateral border of the humerus and extends from the greater tubercle of the humerus proximally to the lateral epicondyle distally.

The length of the approach depends on the method of reduction and fixation.

Subcutaneous fat and fascia are incised following the same incision and retracted with the skin.

Fat and brachial fascia is incised and dissected away to allow visualization of the cephalic vein. The brachial fascia is incised along the lateral border of the brachiocephalic muscle and the cephalic vein.

The cephalic vein can be dissected and moved cranially or caudally for visualization. When necessary, the cephalic vein can be ligated.

For visualization, the craniomedial fascia and the insertion of the lateral head of the triceps brachii on the humerus can be dissected and separated.

The periosteal insertion of the superficial pectoral and brachiocephalic muscles on the humeral shaft can be incised for greater exposure.

Note: The radial nerve should be identified and protected prior to any dissection in this region.

The brachialis and triceps muscles are retracted caudally. The radial nerve can be retracted with the brachialis muscle with gentle traction. Umbilical tape or vessel loops are good options for gentle retraction.

If more exposure is required, the biceps, superficial pectoral muscle, and brachiocephalic muscle can be elevated.

If additional exposure of the proximal lateral part of the humeral shaft is needed, the deltoid muscle can be elevated subperiosteally.

The brachialis muscle can be undermined and retracted cranially with the radial nerve to expose the distal humerus further.

Note: It is essential to protect the radial nerve during manipulation.

If the insertions of the superficial pectoral and brachiocephalic muscles were dissected from the bone, they are sutured proximally to the deltoid muscle and distally to the superficial fascia of the brachialis muscle.

The lateral head of the triceps is attached to the brachiocephalic muscle.

Brachial fascia, subcutaneous fat and fascia, and skin are closed in separate layers.