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A lateral approach to the distal humerus following identification of the cutaneous branches of the radial nerve

¹ Department of Orthopaedic Surgery, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France.
² Department of Orthopaedic Surgery, Hôpital Avicenne 125 route de Stalingrad, 93009 Bobigny, France.

Correspondence should be sent to Professor D. Hannouche; e-mail: didier.hannouche{at}lrb.aphp.fr

We describe a lateral approach to the distal humerus based on initial location of the superficial branches of the radial nerve, the inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm. In 18 upper limbs the superficial branches of the radial nerve were located in the subcutaneous tissue between the triceps and brachioradialis muscles and dissected proximally to their origin from the radial nerve, exposing the shaft of the humerus. The inferior lateral cutaneous nerve of the arm arose from the radial nerve at the lower part of the spiral groove, at a mean of 14.2 cm proximal to the lateral epicondyle. The posterior cutaneous nerve of the forearm arose from the inferior lateral cutaneous nerve at a mean of 6.9 cm (6.0 to 8.1) proximal to the lateral epicondyle and descended vertically along the dorsal aspect of the forearm. The size and constant site of emergence between the triceps and brachioradialis muscles constitute a readily identifiable landmark to explore the radial nerve and expose the humeral shaft.