Proximal Humerus
The description of fixation using the deltoid split approach limiting the skin incision is near impossible to achieve in a young adult with good musculature.
It is quite unnecessary to limit the skin incision just because the nerve ( which is very deep inside) lies within 5 cms of the acromion. Why should a skin incision injure the nerve?
I would argue that the skin incision can be of any length required to reduce the fracture and comfortably place the plate without endangering the nerve.
It is also unnecessarily messy to pass the sutures of the tuberosities through the plate, before applying the plate to the bone. Much better to reduce the tuberosities first, fix the plate and then pass the tuberosity sutures through the relevant holes.
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12 Jan
Michela Abbruzzese AdminHighlighted comment
Dear Doctor,
Thank you very much indeed for your important observations and comments regarding the proximal humerus fracture fixation content.
We acknowledge that there is a range of opinion with respect to the trans-deltoid surgical approach and how to protect the axillary nerve. We hope that AO Surgery Reference reflects that range of opinion but must err on the side of caution in order to reduce the risk of intraoperative adverse events in the hands of less-experienced surgeons than yourself.
We also agree that there are different techniques for applying sutures to the tuberosities in relation to the buttressing plate. We acknowledge that different styles of lateral buttressing plate require different suture management techniques. We illustrate one technique because it is the most commonly used and taught in the AO Upper Extremity trauma courses. We hope this answers your important concerns.
Thank you very much for taking an interest in the accuracy and validity of the content.