Introduction: The anterior and anterolateral approaches to the humerus describe splitting brachialis longitudinally, assuming its fibres run parallel to the shaft. A recent anatomic study has demonstrated the predictability of the position of the axillary nerve as it crosses the anterior deltoid raphe, which allows it to be isolated and protected, and dissection can be extended distally. In addition, no accessory motor branches to the anterior head of the deltoid cross the raphe, so extending an incision through the raphe after protecting the main motor branch of the axillary does not place the innervation to the anterior deltoid at risk. This the Modified Gerwin Approach allows exposure of the proximal humerus and indirect reduction of the fracture, with subsequent locking plate fixation, adhering to the principles of biological fixation.

Method: Surgical Technique Patient positioning: Supine or beach-chair position. Incision: Anterolateral incision (3-6 cm) between the deltoid and biceps muscles. Dissection: Interval between deltoid and biceps muscles developed. Retraction: Deltoid muscle retracted posteriorly; biceps muscle retracted anteriorly. Humerus exposure: Radial nerve and profunda brachii artery identified and protected. Procedure-specific steps: Perform fracture fixation, tumor resection, infection management, or neurological procedure.

Results: Advantages. Minimal muscle damage. Excellent visualization of proximal humerus. Reduced risk of radial nerve injury. Easy conversion to deltpectoral approach. Potential Complications. Radial nerve injury. Axillary artery damage. Infection. Fracture or hardware failure. Muscle weakness or atrophy

Conclusions: Improved anatomical understanding The Modified Gerwin Approach surgical exposure to the proximal humerus provides the largest humeral exposure with the greatest visibility of landmarks relative to the most widely utilized standard approaches. Minimal muscle damage with excellent visualization of proximal humerus and reduced risk of radial nerve injury and Easy conversion to deltpectoral approachs demonstrates satisfactory outcomes using this approach.