Hemorrhagic subdeltoid bursal tissue may need to be excised to expose the humeral head. Anatomical landmarksAnatomical landmarks for the anterolateral approach are: A) Anterolateral edge of the acromionB) Lateral side of the proximal humeral shaft. This nerve encircles the proximal humerus a little less than half way from the lateral margin of the acromion to the insertion of the deltoid muscle. This distance does not significantly vary and is reliable. Neurovascular structuresThe course of the axillary nerve must be kept in mind. Pearl: stay suture In order to protect the axillary nerve from uncontrolled distal dissection, a stay suture may be placed at the inferior border of the deltoid raphe. The length of the skin incision depends on fracture complexity. In addition, it is safe to use in polytraumatized patients … Note: The anterior motor branch of the axillary nerve crosses the humerus horizontally about 6 cm distal to the lateral border of the acromion. Some surgeons place a drain beneath the deltoid muscle. Insert a guide pin in this location. Proximal Humerus Fracture Fixation Using a Locked Plate-Screw Construct ... ORIF of proximal humerus fracture through an anterolateral approach. Proximally, the deltopectoral approach to the shoulder continues to be the most widely used. This approach utilizes a relatively avascular plane, away from the anterior and posterior circumflex humeral arteries. After surgery irrigate the wound. If a plate is to be passed underneath the axillary nerve, as in minimally invasive plate osteosynthesis (MIPO), mark a second line 2 cm distal to the first, below which the axillary nerve should not be encountered. In these cases, sutures can be omitted, however, they help to protect the tendon edges during nail insertion. ORIF of a valgus three part proximal humerus fracture through the anterolateral acromial approach, using the raphe between the anterior and middle heads … Palpate the axillary nerve on the deep surface of the deltoid muscle, distal to the incision. © 2009 - 2020 All rights reserved Proximal Humerus Fracture: ORIF with Calcar Support, Point-Counterpoint: Proximal Humerus Fractures ORIF IM Nails are Better. Superior Capsular Reconstruction following ORIF of a Proximal Humerus Fr... Personalised 3D Molding Technique for fixing Proximal Humeral Fractures, Interactive Upper Extremity Case Presentations, Conversion of Failed ORIF to Reverse Shoulder, FORE 2018 30th Annual Orthopaedic Trauma Update: A Tale of Two Cities, Displaced Three Part Proximal Humerus - ORIF/Plate/Nail, Proximal Humerus Fractures - Locked Plating. The space between these two lines is the danger zone on the lateral humerus. In less complex cases with only slight fragment displacement and where reduction can be performed in a closed manner, the nail can be inserted through a minimal skin incision. Expose and dissect the raphe of the deltoid muscle between the anterior and medial portion of its fibers. Insert a guide pin in this location. As shown, this approach provides safe and effective access to the humeral shaft. Safely below the marked (blue lines) axillary nerve, stab incisions may be made for screws to fix a plate to the humeral shaft. Privacy policy, ORIF of a valgus three part proximal humerus fracture through the anterolateral acromial approach, using. The ideal entry point is usually located just medial to the greater tuberosity, slightly lateral to the axis of the medullary canal on the AP view and in line with humeral axis on the lateral view. Objective: Anterolateral approaches for proximal humerus osteosynthesis have great advantages because they allow direct exposure of the lateral aspect of the humerus without the muscular retraction seen in the deltopectoral approach. Make a short incision in line with its fibers and place stay sutures on each side of the insertion. Axillary nerveBefore incising the skin, mark the distal limit of the approach, 5cm below the acromion, which is 1 cm above the course of the axillary nerve. Avoid the tendon of the long head of the biceps. It is especially useful for nailing and osteosynthesis of fractures of the greater tuberosity. A special aiming device may be available for this purpose. Advances in Proximal Humerus Nailing: Rationale & Techniques, ORIF of Proximal Humerus Fracture using Locked Plating, Proximal Humerus ORIF: Exposure and Reduction Techniques, Proximal Humeral Fracture Fixation Using a Precontoured Locking Plate, Open Reduction and Locking Plate Fixation for Proximal Humerus Fractures, American Shoulder and Elbow Surgeons 2010, Point-Counterpoint: Proximal Humerus Fractures ORIF 10 Tips to Success, Avoiding Complications for Locked Plating for Proximal Humerus Fractures, ORIF of a 3-Part Proximal Humerus Fracture. The anterolateral acromion approach of the shoulder is a popular approach for the treatment of proximal humeral fractures, especially in minimally invasive plate osteosynthesis (MIPO) technique. The ideal entry point is located in straight line with the axis of the medullary canal. Close the anteromedial raphe, the subcutaneous tissues, and the skin. Anterolateral approach to the humerus (after Henry) and many more surgical approaches described step by step with text and illustrations. Partially release the deltoid insertion anteriorly, if necessary, and retract laterally to access the proximal humerus. It is also recommended for minimally invasive plate osteosynthesis (MIPO). Skin incisionMake a skin incision from the anterior border of the acromion for 5 cm distally, parallel to the axis of the humerus. Split the raphe, in line with the deltoid fibers, to obtain a fairly avascular approach to underlying structures. One can find the correct entry point medial to the greater tuberosity, typically at the highest point of the humeral head slightly posterior to the bicipital groove. the proximal humeral shaft, many surgeons prefer the anterolateral approach because it uses the internervous plane between the axillary and deltoid nerves proximally and the radial and musculocutaneous nerves distally.

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