Technical note: reduction of a posteriorly dislocated humeral head via the anterior deltopectoral approach in a posterior fracture dislocation of the proximal humerus.

Abstract

We aim to describe an approach for reducing the posteriorly dislocated humeral head through the rotator interval via a deltopectoral approach that is frequently utilized for internal fixation of proximal humerus fractures and fracture dislocations. The sheath of the long head of biceps (LHB) and the rotator interval capsule are opened till the glenoid; this enables access to the glenohumeral joint via the rotator interval. A long-handle Cobb elevator is introduced through the rotator interval and, under intraoperative imaging, advanced posteromedially to the dislocated humeral head. After ensuring that the Cobb elevator is embracing the humeral head posteriorly, the head is gently pushed by the Cobb elevator in a posteromedial to anterolateral direction until it reduces in front of the glenoid. The rest of the steps for locking plate fixation may be performed as per the surgeon's choice. The described technique avoids posterior dissection and preserves the integrity of the intertuberosity periosteum, even in the presence of a fracture between the tuberosities. The rotator interval approach does not violate the rotator cuff attachments on the tuberosities and the capsular attachments on the neck of the humerus.