Authors of section

Authors

Jonas Andermahr, Michael McKee, Diane Nam

Executive Editor

Joseph Schatzker

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Superior approach to the acromion

1. Introduction

The superior extension of the anterior
deltoid split can be used for treatments of simple acromion fractures and nailing of proximal humeral fractures.

superior approach to the acromion

This incision is placed in the acromial part (2) of the deltoid muscle, as illustrated.

If needed this approach may be extended inferiorly to the standard deltoid split.

Indications

2. Neurovascular structures

The course of the axillary nerve must be kept in mind if the approach is extended inferiorly.

Note: The anterior motor branch of the axillary nerve crosses the humerus horizontally about 6 cm distal to the lateral border of the acromion. This distance does not significantly vary in individuals of the same size and is a reliable guide.

Neurovascular structures

3. Anatomical landmarks

Anatomical landmarks for the superior delta split approach are:

A) The acromion
B) The major tuberosity of the humerus
C) The scapular spine

These landmarks can easily be palpated.

Anatomical landmarks

4. Skin incision

The incision starts approximately at the midpoint of the greater tuberosity and aims towards the scapular spine, crossing just posterior to the anterior tip of the acromion.

Skin incision

5. Exposure

The deltoid is split in the direction of its fibers. One might have to release partially the deltoid anteriorly and the trapezius posteriorly in order to expose the full extent of the fracture.

Exposure

6. Wound closure

Reattach the released muscles; close in layers, close the fascia, and subcutaneous plane, and then the skin.

Wound closure