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Mastering the Anterior Approach to the Humerus: Surgical Anatomy, Indications, & Techniques

Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus

30 مارس 2026 7 min read 133 Views
Minimally Invasive Anterolateral Approach to the Proximal Humerus: A Step-by-Step Guide

Key Takeaway

Here are the crucial details you must know about Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus. The minimally invasive anterolateral approach to the proximal humerus is a surgical technique for inserting intramedullary nails. It treats acute, pathologic, or nonunion humeral shaft fractures. This approach involves a 2-cm incision from the acromion, splitting the deltoid muscle, and precisely identifying the humeral entry point for optimal fracture stabilization.

This article provides a detailed step-by-step guide to the minimally invasive anterolateral approach to the proximal humerus. The approach is used for the insertion of intramedullary nails for the treatment of acute humeral shaft fractures, pathologic humeral shaft fractures, and delayed union and nonunion of humeral shaft fractures.

Dr.Mohammad Hutaif , Emial
Google Scholar citation
The minimally invasive approach to the proximal humerus is used for the insertion of intramedullary nails for the treatment of the following:
1. Acute humeral shaft fractures 2. Pathologic humeral shaft fractures 3. Delayed union and nonunion of humeral shaft fractures The presence of the overlying acromion and the fact that the upper end of the humerus is covered entirely with articular cartilage mean that most nails are angled at their upper end and are inserted via the lateral cortex of the humerus. The entry point for an intermedullary nail into the humerus is determined radiographically, with a template of the required nail superimposed over a radiograph of the injured humerus. The entry point depends on the specific design of the nail. The most usual entry point is just lateral to the articular surface of the humeral head and just medial to the greater tuberosity (see Fig. 1-50).

Place the patient in a supine position. Elevate the upper portion of the table to approximately 60 degrees . Position the patient so that the shoulder lies over the edge of the table. Alternatively, use a specialized table that allows radiographic visualization of the shoulder in both anterior–posterior and lateral planes. Ensure that the cervical spine is adequately supported and that lateral flexion of the cervical spine is avoided to prevent a traction lesion of the brachial plexus.
Illustration 1 for Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus

Figure 1-46 Palpate the lateral border of the acromion and then make a 2-cm incision from that border down the lateral aspect of the arm. Landmarks and Incision Landmark The _acromion_1-47). This position has been determined on the preoperative x-ray plan. Confirm that the wire is in the correct position by the use of a C-arm image intensifier in both anterior–
posterior and lateral planes.
Illustration 2 for Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus

Figure 1-47 Insert a guidewire through the substance of the deltoid muscle under image intensifier control.
Illustration 3 for Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus

Illustration 4 for Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus Figure 1-48 Enlarge the track made by the wire using a point-ended scalpel. You will incise part of the deltoid and part of the supraspinatus tendon.
1-49 and 1-50). Dang Nerves The axillary nerve lies approximately 7 cm below the tip of the acromion, running transversely on the deep aspect of the deltoid muscle.
The brachial artery and median nerve lie medial to the proximal humerus. They are also at risk during insertion of proximal locking bolts. This incision should, therefore, not risk damage to the axillary nerve (see How to Enlarge the Approach Extensile Measures Distal Extension. The approach can be extended to a formal lateral approach to the proximal humerus. This extension may be needed if closed reduction of proximal humeral fractures cannot be obtained (see Fig. 1-39)._
Illustration 5 for Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus

Figure 1-49 Insert the wire into the proximal end of the humerus under image intensifier control.
Illustration 6 for Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus

Illustration 7 for Step-by-Step Guide: Minimally Invasive Approach to the Proximal Humerus
Figure 1-50 Lateral view of the shoulder, revealing insertion of the guidewire. The most common entry point is just lateral to the articular surface of the humeral head and just medial to the greater tuberosity.
Minimally Invasive Anterolateral Approach to the Proximal Humerus

Minimally Invasive Anterolateral Approach to the Proximal Humerus

What is the minimally invasive anterolateral approach to the proximal humerus used for?

  1. Acute humeral shaft fractures
  2. Pathologic humeral shaft fractures
  3. Delayed union and nonunion of humeral shaft fractures

What is the position of the patient for the minimally invasive anterolateral approach to the proximal humerus?

  1. Supine

What is the landmark for the minimally invasive anterolateral approach to the proximal humerus?

  1. Acromion

What is the incision for the minimally invasive anterolateral approach to the proximal humerus?

  1. 2 cm incision from the outer aspect of the acromion down the lateral aspect of the arm

What is the internervous plane for the minimally invasive anterolateral approach to the proximal humerus?

  1. Between the deltoid and the pectoralis major muscles

What is the first step in the minimally invasive anterolateral approach to the proximal humerus?

  1. Make a skin incision

What is the second step in the minimally invasive anterolateral approach to the proximal humerus?

  1. Dissect the deltoid muscle

What is the third step in the minimally invasive anterolateral approach to the proximal humerus?

  1. Insert a wire through the skin incision Figure 1-50 Lateral view of the shoulder, revealing insertion of the guidewire. The most common entry point is just lateral to the articular surface of the humeral head and just medial to the greater tuberosity.
    Minimally Invasive Anterolateral Approach to the Proximal Humerus Minimally Invasive Anterolateral Approach to the Proximal Humerus What is the minimally invasive anterolateral approach to the proximal humerus used for? What is the position of the patient for the minimally invasive anterolateral approach to the proximal humerus? What is the landmark for the minimally invasive anterolateral approach to the proximal humerus? What is the incision for the minimally invasive anterolateral approach to the proximal humerus? What is the internervous plane for the minimally invasive anterolateral approach to the proximal humerus? What is the first step in the minimally invasive anterolateral approach to the proximal humerus? What is the second step in the minimally invasive anterolateral approach to the proximal humerus? What is the third step in the minimally invasive anterolateral approach to the proximal humerus?

Scientific References

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Humeral Shaft Anterior Approach: Master Surgical Techniques
Humeral Shaft Anterior Approach: Master Surgical Techniques
Previous ChapterMastering the Minimally Invasive Anterior Humeral Shaft App…
Dr. Mohammed Hutaif
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Prof. Dr. Mohammed Hutaif
Consultant Orthopedic & Spine Surgeon
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