Plate Fixation of Proximal Humeral Fractures Wheeless

Description: - indicated for displaced surgical neck, 3 part, and 4 part fracture;
- Anterior Approach to Shoulder:
- incision is made along medial border of deltoid extending laterally to humeral shaft;
- cephalic vein protected;
- superior part of pectoralis may have to be divided;
- deltoid detachment:
- when greater access to proximal humerus is required, more extensive removal of deltoid is required;
- deltoid muscle should be removed from clavicle by raising an osteoperiosteal flap laterally to the acromion;
- reduction:
- lesser tuberosity will be found attached to subscapularis and the rotator cuff to the greater tuberosity;
- often two are combined as a single fragment, with the long head of biceps tendon running thru it;
Wheeless' Textbook of Orthopaedics