1. Surgical Approaches around the Shoulder for Trauma SE Aldridge Jan 2008 SE Aldridge Jan 2008

2. Indications for operative intervention Clavicle fracture Glenoid neck fracture Proximal Humerus IM nailing of diaphyseal humerus Clavicle fracture Glenoid neck fracture Proximal Humerus IM nailing of diaphyseal humerus

3. Position Beach chair Supine Lateral decubitus Beach chair Supine Lateral decubitus

4. Clavicle Subcutaneous bone Direct approach Dangers: Neurovascular structures at risk from screw placement Subcutaneous bone Direct approach Dangers: Neurovascular structures at risk from screw placement

5. Clavicle

6. AC Joint Direct superior approach For ACJ dislocation dissection often already done by injury. Direct superior approach For ACJ dislocation dissection often already done by injury.

7. Proximal Humerus Treatment options: Non-operative Closed reduction + internal fixation Open reduction + internal fixation Hemiarthroplasty Treatment options: Non-operative Closed reduction + internal fixation Open reduction + internal fixation Hemiarthroplasty

8. Approach to Prox Humerus Deltopectoral ORIF Hemiarthroplasty Deltoid splitting Nail MIPPO Percutaneous Tuberosity fractures Deltopectoral ORIF Hemiarthroplasty Deltoid splitting Nail MIPPO Percutaneous Tuberosity fractures

9. Deltopectoral Approach Positioning: Beach chair Fluoroscopy Access Positioning: Beach chair Fluoroscopy Access

10. Deltopectoral

17. Dangers Musculocutaneous nerve coracobrachialis 5-8cm Axillary nerve inferior to subscap Dangers Musculocutaneous nerve coracobrachialis 5-8cm Axillary nerve inferior to subscap

18. Deltoid splitting Positioning: Beach chair Indication: Tuberosity fractures IM nailing MIPPO (consider lateral position) Positioning: Beach chair Indication: Tuberosity fractures IM nailing MIPPO (consider lateral position)

19. Deltoid splitting

24. Dangers: Axillary nerve 7cm below tip of acromion Dangers: Axillary nerve 7cm below tip of acromion

25. MIPPO Deltoid splitting: Blunt Dissect undersurface of deltoid distally Palpate axillary nerve superficially Distal incision over humerus Connect tunnel Deltoid splitting: Blunt Dissect undersurface of deltoid distally Palpate axillary nerve superficially Distal incision over humerus Connect tunnel

26. Glenoid and Scapula Neck Posterior approach: Lateral Decubitus Position Posterior approach: Lateral Decubitus Position

27. Posterior Approach

32. Dangers: Axillary N. + P. circumflex humeral art. Quadrangular space Radial Nerve Triangular space Suprascapular N. + Circumflex Scapular vessels Scapula neck Dangers: Axillary N. + P. circumflex humeral art. Quadrangular space Radial Nerve Triangular space Suprascapular N. + Circumflex Scapular vessels Scapula neck

33. Other approaches Anterolateral: Transverse incision Deltoid either split or reflected from its origin Arthroscopy Anterolateral: Transverse incision Deltoid either split or reflected from its origin Arthroscopy

34. More information www.aofoundation.org/portal/wps/portal/surgery Information on decision making about treatment,approach and setup. Surgical Exposures in Orthopaedics. The Anatomic Approach. - Hoppenfeld www.aofoundation.org/portal/wps/portal/surgery Information on decision making about treatment,approach and setup. Surgical Exposures in Orthopaedics. The Anatomic Approach. - Hoppenfeld

35. Thank you