Chinese Journal of Tissue Engineering Research ›› 2011, Vol. 15 ›› Issue (35): 6461-6465.doi: 10.3969/j.issn.1673-8225.2011.35.001

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Surgical anatomy of extended anterolateral acromial approach for internal fixation of proximal humeral fracturesm

Zhou Guo-xin1, Hou Zhi-qi1, Tan Ping-xian2, Ye Gan-hu2, Yao Huo-sheng3, Huang Zhi-song3   

  1. 1Department of Joint Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou  510180, Guangdong Province, China
    2Department of Orthopedics, Changping Hospital of Dongguan City, Dongguan  523573, Guangdong Province, China
    3Department of Anatomy, Zhongshan School of Medcine, Sun Yat-sen University, Guangzhou  510010, Guangdong Province, China
  • Received:2011-02-09 Revised:2011-03-24 Online:2011-08-27 Published:2011-08-27
  • Contact: Hou Zhi-qi, Professor, Chief physician, Department of Joint Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China smilehouzq@yahoo.com.cn
  • About author:Zhou Guo-xin★, Studying for master’s degree, Attending physician, Department of Joint Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China kenrry.zhou@sohu.com

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Abstract:

BACKGROUND: There are many surgical approaches for the shoulder joint. Two of which are widely used for proximal humeral fractures in clinic: the deltopectoral approach and the anterolateral acromia approach. However, the existing surgical approaches have some limitations.
OBJECTIVE: To observe the courses of the axillary nerve and relative structures of humerus and deltoid from lateral arm, and to provide the anatomical information of a new surgical approach for proximal humeral fracture.
METHODS: Twelve adult cadaveric upper limbs (male 7, female 5) were dissected to define the course of the anterior branch of axillary nerve in the anterior and middle compartments of deltoid muscle, measure the relative distance of them, compare the characteristics of the axillary nerve as it crosses the raphe between the middle and anterior heads of the deltoid.Simulation of surgical operation was implemented on a corpse after the initial data collection had been conducted.
RESULTS AND CONCLUSION: The anterior branch of axillary nerve passed through the upper 1/3 of the deltoid muscle, the crossing of the anterior branch of axillary nerve and the line from the lateral tip of acromion to deltoidtuberosity was (6.0±1.3) cm below the level of acromon. A single motor branch was found to distribute the anterior head of the deltoid. An avascular raphe was located between the anterior and middle heads of the deltoid. The raphe could be identified as a white band of connective tissue between the two muscular heads. No branches to the anterior head of the deltoid cross the raphe was found. The cross stitch length in this group were greater than 1 cm, the tension of the axillary nerve was low after the plate was implanted. Through the raphe between the two muscular heads of deltoid, a surgical approach could be created for the exposure of proximal humerus, with easily extending distally after protecting the main motor branch of the axillary. This surgical approach is safe for fracture reduction directly, with subsequent plate fixation.

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