Plating of proximal humeral shaft fractures may be performed through the anterolateral approach. This approach can be extended distally for midshaft fractures (see lateral approach).
The lateral approach allows safe exposure of the distal two thirds of the humerus. It can be extended proximally also to expose the proximal humerus (see anterolateral approach).
This approach is most commonly used for fractures involving the distal half of the humerus. However, it can be extended for more proximal fractures, once the radial nerve has been identified.
The minimally invasive osteosynthesis approach allows for subcutaneous plate insertion through a tunnel.
Antegrade nailing approach
The humeral head is exposed via a superior incision and the entry point is determined. An entry portal in the humerus is made using a cannulated awl inserted over a guide wire.
Retrograde nailing approach
The medial and lateral supracondylar ridges and the olecranon fossa are used to identify the entry point. A 1 cm diameter supracondylar entry portal is made in the posterior cortex using a burr.
Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.