Robinson and Murray describe the variations and extensions of the extended deltoid-splitting approach to the proximal humerus — a technique developed in Edinburgh in 1997 — detailing two skin incision options, nerve protection strategy, and how the approach can be extended for diaphyseal fractures. The paper also reports outcomes from 386 cases treated over 12 years.
When operating on a Neer 3- or 4-part fracture — especially with posterior greater tuberosity retraction or diaphyseal extension.
The extended deltoid-splitting approach gives you direct lateral access that the deltopectoral approach cannot: identify the axillary nerve first, protect it with a sling, then work in the two windows around it. If you need to go past the deltoid insertion, identify the radial nerve as well.
Robinson and Murray describe the variations and extensions of the extended deltoid-splitting approach to the proximal humerus — a technique developed in Edinburgh in 1997 — detailing two skin incision options, nerve protection strategy, and how the approach can be extended for diaphyseal fractures. The paper also reports outcomes from 386 cases treated over 12 years.
When operating on a Neer 3- or 4-part fracture — especially with posterior greater tuberosity retraction or diaphyseal extension.
The extended deltoid-splitting approach gives you direct lateral access that the deltopectoral approach cannot: identify the axillary nerve first, protect it with a sling, then work in the two windows around it. If you need to go past the deltoid insertion, identify the radial nerve as well.