Executive Editor: Chris Colton, Steve Krikler

Authors: Pol Rommens, Peter Trafton, Martin Jaeger

Humeral shaft

Overview

Safe zones i

Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.

Antegrade nailing approach i

The humeral head is exposed via an anterolateral incision and the entry point is determined. Antegrade nailing involves entry through the rotator cuff. Care should be taken to minimize injury, and to repair the tendon.

Retrograde nailing approach i

The retrograde nailing approach requires opening the medullary canal just proximal to the olecranon fossa. The soft tissues are opened longitudinally in the line of the humeral shaft.

MIO approach (anterior) i

The minimally invasive osteosynthesis approach allows for subcutaneous plate insertion through a tunnel. Typically, the plate will be introduced through the distal portal.

MIO transdeltoid approach i

The MIO transdeltoid lateral approach can be used for the more proximal humeral shaft fractures. It is especially useful if there is an extension of the fracture into the greater tuberosity.

Anterolateral approach i

Plating of proximal humeral shaft fractures may be performed through the anterolateral approach. This approach can be extended distally for midshaft fractures.

Extended deltopectoral approach i

The (anterior) extended deltopectoral approach can be used to access almost any humeral shaft fracture involving the proximal 4/5.

Lateral approach i

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.

Posterior triceps-split approach i

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.

Posterior triceps-on approach i

For midshaft and distal shaft fractures, the posterior approach may be extended distally, leaving the triceps insertion intact. This provides adequate exposure for reduction and fixation.

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v2.0 2018-12-28