Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.
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.
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.
The minimally invasive osteosynthesis approach allows for subcutaneous plate insertion through a tunnel. Typically, the plate will be introduced through the distal portal.
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.
Plating of proximal humeral shaft fractures may be performed through the anterolateral approach. This approach can be extended distally for midshaft fractures.
The (anterior) extended deltopectoral approach can be used to access almost any humeral shaft fracture involving the proximal 4/5.
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.
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.
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.