Minimal access approach to proximal humerus

Indications

insertion of humeral nail

Principles

Entry point
- Lateral to articular surface of humeral head
- Medial to greater tuberosity

Position

supine
beach chair 60°
shoulder is over edge of table
Mayfield head rest
Image intensifier

Landmarks

acromion

Incision

2cm longitudinal incision
Start: outer aspect of acromion
End

Internervous Plane

Deltoid splitting

Superficial Dissection

Insert guide wire under II control
Cut down onto wire with scalpel through deltoid & supraspinatus

Dangers

Nerves
- Axillary
Tendons
- supraspinatus