Deltopectoral Approach to the Proximal Humerus

This Surgical Guidance video with Diane Nam and George Dyer presents a detailed demonstration of the deltopectoral approach to the proximal humerus, with a focus on safe exposure, reliable anatomical orientation and soft-tissue control in trauma surgery. The chapter begins with patient positioning, explaining that the approach can be performed in either a beach chair position or supine on a radiolucent table. In the demonstrated setup, the shoulder is positioned at a practical working height, with the arm free-draped to allow movement throughout the procedure.
The video then walks through the key surface landmarks used to plan the incision, including the acromion, clavicle, scapular spine, acromioclavicular joint and coracoid process. Particular emphasis is placed on identifying the coracoid accurately, as it helps guide the deltopectoral interval and supports orientation throughout the exposure. The incision is marked in relation to the coracoid and humeral shaft, keeping the approach extensile while avoiding unnecessary incision length.
A major focus of the demonstration is careful development of the deltopectoral interval. The cephalic vein is identified as the first important landmark, and the faculty explain the rationale for mobilizing it medially to help preserve the vessel. The video highlights how to avoid intramuscular dissection, how to use proximal anatomy when the interval is difficult to identify distally, and how to preserve the pectoralis insertion. It also demonstrates exposure of the conjoint tendon, subdeltoid plane and relevant neurovascular structures, including the musculocutaneous and axillary nerves.
The later part of the video focuses on defining the “box” of the subscapularis tendon, bordered medially by the coracoid and conjoint tendon, laterally by the biceps and bicipital groove, superiorly by the rotator interval and inferiorly by the anterior circumflex vessels. The faculty demonstrate tagging of the subscapularis, supraspinatus, infraspinatus and teres minor tendons, emphasizing that proximal humerus fracture fixation is also a soft-tissue procedure centered on controlling the rotator cuff and tuberosities. The video closes by showing how these sutures support exposure and how the axillary nerve can be located safely during the approach.