title: The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus.
abstract: Lateral approaches to the proximal humerus have been limited by the position of the axillary nerve. Extensive surgical dissection through a deltopectoral approach may further damage the remaining tenuous blood supply in comminuted fractures. The purpose of our study was to explore a direct anterolateral, less invasive approach to the proximal humerus. Twenty cadaver shoulders were dissected using the extended anterolateral acromial approach through the anterior deltoid raphe. Multiple parameters were measured regarding the axillary nerve. The nerve was easily palpable in all specimens as it exited the quadrilateral space, and predictably was found and protected deep to the raphe, approximately 35 mm from the prominence of the greater tuberosity. Examination of the entire anterior nerve revealed that no branches besides the main motor trunk crossed the deltoid raphe. Subsequently, this approach was used in 16 patients with proximal humerus fractures, none of whom has had complications related to the surgical approach. This minimally invasive surgical approach seems to be safe, and may be useful in treating proximal humerus fractures.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. gardnerm@hss.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Griffith
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Briggs
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Weiland
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000174:Acromion / Q000033:anatomy & histology / Q000294:innervation / Q000601:surgery; D000368:Aged; D001860:Bone Plates; D001917:Brachial Plexus / Q000033:anatomy & histology / Q000601:surgery; D002102:Cadaver; D004210:Dissection; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012782:Shoulder / Q000033:anatomy & histology / Q000294:innervation / Q000601:surgery*