Superior scapular approach

The superior and dorsal extension of the anterior deltoid split can be used for treatment of acromial fractures.

This incision is placed between the clavicular part (1) and the acromial part (2) of the deltoid muscle, as illustrated.

If indicated, this approach may be extended distally into the anterolateral deltoid split approach.

This approach can be used to treat periprosthetic fractures of the acromion.

Anatomical landmarks for the superior approach to the acromion are:

• The acromion
• The acromioclavicular joint
• The scapular spine

These landmarks can be palpated easily.

The incision starts anterolateral to the acromion, and aims towards the scapular spine, passing posterior to the acromioclavicular joint.

The deltoid is split in the direction of its fibers. It may be necessary to partially release the deltoid anteriorly and the trapezius posteriorly to expose the full extent of the fracture.

Reattach the released muscles. The subcutaneous fascia and the skin are closed in layers.