Anterolateral Acromial Approach Through a Shoulder Strap Incision

Description

This video transcription details a surgical procedure conducted by Ashok Gavaskar involving an extended deltoid split approach for the treatment of a two-part surgical neck fracture of the humerus in an obese patient. The patient is positioned in a beach chair stance with specific imaging assistance for optimal visualization. The surgical site is prepared with an inverted U incision marked from the acromion. Key steps include careful identification of the axillary nerve and gradual raising of skin flaps while minimizing bleeding through careful infiltration of local anesthetic. Adequate exposure is achieved via muscle splitting, allowing for safe fracture reduction and fixation using a three-hole plate. Various surgical techniques and tools, such as k-wires and reduction screws, are described for ensuring proper alignment and stabilization of the fractured humeral head and shaft, with emphasis on techniques to avoid inter-articular penetration during screw placement. The importance of meticulous suture placement is underscored for maintaining stability in complex fracture scenarios. Throughout the procedure, the positioning and fixation of plates and screws are confirmed via fluoroscopy to ensure optimal patient outcomes.

DOI: 10.1302/3114-230006

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