The lateral and anterior lateral approaches are the most commonly used for antegrade nailing of humerus fractures. However, the surgical exposure is restricted by the bony acromion. The iatrogenic injury to the rotator cuff can also cause post-operative pain and compromise shoulder function. This article describes a new rotator interval approach that we used for central entry point nailing. In this approach, the skin incision starts from the midpoint between the acromion and coracoid process. A trans-rotator interval split in front of the anterior border of the supraspinatus (SSP) tendon is then made to open the glenohumeral joint. With the SSP retracted laterally and the long head of the biceps (LHB) retracted medially, the humeral head is directly visualized. The entry point can thus be determined and confirmed by intra-operative fluoroscopy in both axial and AP planes. We recommend this rotator interval approach as an alternative nailing technique for 2-part humeral neck fractures and humeral shaft fractures.
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