Access passage

Access passage
Access passage is carried out according to each surgeon's skill, it means that following description of the stages is a mere indication. Patient should be half seated on an operating table inclined by 30°. Head should be supported so as to avoid excess straining of the neck. Arm should be left free and a small cushion be placed under the shoulder. It is recommended to use a self sticking cutaneous film.

Delto-pectoral access passage
This is the most frequent passage, length of is ranging from 12 to 14 cm down to armpit bend. The cephalic vein should be either protected or ligated, delto-pectoral line remaining open. Under certain circumstances, it si necessary to release front head of the deltoid. Coraco-acromial ligament excised. Abduction and external rolling of the arm set the deltoid loose easing its retraction to obtain quite a satisfactory space.

Articular access passage
This articular access passage depends upon the tuberosities' state. In compound fractures with cephalic tuberosities, a part of the tuberosity is frequently broken in several pieces, main part of each being vertical. It is often possible not to cut under scapular muscle by retracting great tuberosity outside and lesser tuberosity inside. In case of old fractures and pseudo-arthrosis, a tuberosity osteotomy could ease the access between tuberosities. In all other cases, it is recommended to use a standard articular access passage by cutting the front of under scapular and articular capsule. Dislocation of the articulation is obtained by rolling the forearm ahead. Different humeral and glenoid stages are perfectly developed by NEER. Nevertheless some of them are reminded in the following pages.