Technical TrickA Preoperative Planning Tool: Aggregate Anterior Approach to the Humerus With Quantitative ComparisonsPhelps, Kevin D. MD*; Harmer, Luke S. MD, MPH†; Crickard, Colin V. MD‡; Hamid, Nady MD§; Sample, Katherine M. BS, BA║; Andrews, Erica B. BS║; Seymour, Rachel B. PhD¶; Hsu, Joseph R. MD** Author Information *Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; †Quincy Medical Group, Quincy, IL; ‡Commander, Medical Corps, United States Navy, Naval Medical Center, Portsmouth, VA; §OrthoCarolina Shoulder and Elbow Center, OrthoCarolina, Charlotte, NC; ║Department of Orthopaedic Clinical Research, Carolinas Medical Center, Charlotte, NC; ¶Orthopaedic Clinical Research, Department of Orthopaedics, Carolinas Medical Center, Charlotte, NC; and **Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC. Reprints: Kevin D. Phelps, MD, CMC Orthopaedic Surgery, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204 (e-mail: [email protected]). The authors report no conflict of interest. Presented as a Podium Presentation at the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 3, 2016, Orlando, FL. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com). Journal of Orthopaedic Trauma: June 2018 - Volume 32 - Issue 6 - p e229-e236 doi: 10.1097/BOT.0000000000001157 Buy SDC Metrics Abstract Summary: Extensile approaches to the humerus are often needed when treating complex proximal or distal fractures that have extension into the humeral shaft or in those fractures that occur around implants. The 2 most commonly used approaches for more complex fractures include the modified lateral paratricipital approach and the deltopectoral approach with distal anterior extension. Although the former is well described and quantified, the latter is often associated with variable nomenclature with technical descriptions that can be confusing. Furthermore, a method to expose the entire humerus through an anterior extensile approach has not been described. Here, we illustrate and quantify a technique for connecting anterior humeral approaches in a stepwise fashion to form an aggregate anterior approach (AAA). We also describe a method for further distal extension to expose 100% of the length of the humerus and compare this approach with both the AAA and the lateral paratricipital in terms of access to critical bony landmarks, as well as the length and area of bone exposed. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.