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The Deltoid Lift: A Comparison Study of Exposure Area in Proximal Humeral Approaches
John Dunn, MD1; Nicholas Kusnezov, MD2; Justin Mitchell, DO1; Michael Ting, BS2; Miguel A. Pirela-Cruz, MD3
1William Beaumont Army Medical Center, Fort Bliss, TX; 2Texas Tech University Medical Center, El Paso, TX; 3Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX

Introduction: A novel extensile approach of the proximal humerus which involves release of the deltoid at its insertion was compared to the anterior deltopectoral approach, the lateral non-extensile approach, and the anterolateral extensile approach with deltoid splitting. We hypothesized that the new approach would provide a greater area of exposure and greater access to anatomical landmarks.

Methods: Each approach was done a minimum of eight times on eighteen formalin fixed cadavers. After identifying landmarks, exposure area of exposed humerus was quantified using digital photos and Image J.

Results: The extensile approach with deltoid lift had an average exposure area of 46 cm2 (SD of 5.2 cm2, range of 38 to 53 cm2), and the greater tuberosity, lesser tuberosity, posterior-most aspect of humeral head, superior-most aspect of humeral head were observable through visual inspection. The novel extensile approach provided two times more exposure area than the anterolateral extensile approach with deltoid splitting, the next comparable approach. Comparison of the exposure area for the extensile approach with deltoid lift against all other approaches yielded statistical significance with a P-value < 0.01.

Conclusion: The extensile approach with deltoid lift provided the most exposure area with the greatest visibility of landmarks.

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