humerus mipo = medial = pronator teres = biceps-plate - radial nerve ulnar =

  1. https://journals.lww.com/jbjsoa/FullText/2020/03000/New,_Minimally_Invasive,_Anteromedial_Distal.7.aspx 
  2. New, Minimally Invasive, Anteromedial-Distal Approach for Plate Osteosynthesis of Distal-Third Humeral Shaft Fractures 
    1. An Anatomical Study
      1. Cañada-Oya, Hermenegildo MD1; Cañada-Oya, Sabina MD2; Zarzuela-Jiménez, Cristina MD3; Delgado-Martinez, Alberto D. MD, PhD, FEBOT1,4
      2. JBJS Open Access: January-March 2020 - Volume 5 - Issue 1 - p e0056
    2. Before performing the surgical technique, two 15-hole extra-articular elbow locking compression plates (LCPs) (Extra-Articular Distal Humerus Plate [EADHP]; DePuy Synthes-Johnson & Johnson) were molded using 2 intact humerus bones from other arm specimens (1 left and 1 right) without fracture or deformity. The plate was molded with 2 forceps between the fourth and fifth most distal screws, with its posterior curve inverted slightly at the distal zone. Care was taken not to affect the distal holes of the LCP in order to preserve their characteristics. As the plate works as an internal fixator, a perfect assembly of the plate to the bone was not necessary. The molding of the plate was performed to achieve an adequate fit of the plate to an alternate anatomical area, the anterior side of the medial epicondylar area.
    3. An incision starting 1 cm laterally from the medial border of the medial epicondyle and extending distally 2.5 cm along the anatomical direction of the pronator teres muscular fibers was performed. Posteriorly, the premolded plate was introduced from distal to proximal and fixed distally (Fig. 1). Proximally, the plate was fixed using the anterior MIPO approach, which has been previously described6,7.
    4. The incision began 3 cm proximal to the elbow flexion crease and extended distally another 3 cm (Fig. 3). After the skin incision was made, the medial antebrachial cutaneous nerve was identified and retracted medially, and the basilic vein was also identified and retracted laterally. Then, the proximal portion of the pronator teres belly was exposed, and the muscular incision was performed as described above to access the flat anterior portion of the medial epicondyle, where the distal part of the plate is to be fixed (Fig. 4).
    5.  
    6. The plate was introduced from distal to proximal (Figs. 5 and 6) through the anterior face of the humerus, up to the proximal part of the humeral shaft. Distally, it was positioned 2 mm away from the medial border of the coronoid fossa. A distance of 2 mm was left from the distal border of the plate to the medial epicondyle. Five distal screws were inserted through the same distal approach under direct vision, and 3 screws were inserted through the proximal incision, in the usual MIPO way, as previously reported
    7. This approach has some limitations. With respect to injury, it is not completely risk-free. Specifically, the brachial artery and the median nerve can be damaged while performing tunneling, and the ulnar nerve could also be damaged by the most distal screw in patients with a narrow epicondylar area.

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