- Antegrade nailing approach
Make a small skin incision from the anterolateral edge of the acromion, distally towards the deltoid insertion.
Incise the subcutaneous tissue sharply.
Exposure of the humerus
Split and retract between the deltoid muscle fibers.
Incise the supraspinatus tendon in line with its fibers with pointed scalpel blade. Retract both edges with sutures in the tendon.
Expose a small part of the humeral head cartilage medial to the greater tuberosity.
Pitfall: Damage to rotator cuff
Access to the entry site is through the supraspinatus tendon.
Damage to the rotator cuff is minimized by sharp incision. The edges of the incision are retracted by sutures held by clamps or bent K-wires to avoid damage to the tendon.
If reamers are used, they should be passed carefully through the tendon before reaming.