Anatomical safety and clinical feasibility of percutaneous supraclavicular humeral nailing via the Neviaser portal: a combined cadaveric and clinical study.

BACKGROUND

Antegrade intramedullary nailing via a deltoid-splitting approach is standard for humeral shaft fractures but may compromise the rotator cuff tendon. The Neviaser portal provides a superomedial entry through the supraspinatus muscle belly; however, its safety for nailing, particularly the risk of suprascapular nerve injury, remains uncertain. We aimed to quantify the safety margin between the Neviaser nailing trajectory and the suprascapular nerve in cadavers and to assess the clinical feasibility of the technique.

METHODS

Eight fresh-frozen cadaveric shoulders underwent standardised dissection with simulation of the Neviaser portal using an 11-mm protective sheath. Four morphometric parameters were measured. A retrospective cohort of nine patients with humeral shaft fractures was analysed.

RESULTS

Median distances were 45 mm (35-55) from the acromion to the suprascapular notch, 21.5 mm (16-28) for the portal interval, from the sheath to the nerve 32.5 mm (21-34) at the suprascapular notch, and 19.5 mm (16-25) at the spinoglenoid notch. All trajectories traversed the supraspinatus muscle belly. Clinically, all fractures united by a median ofthree months, with low pain, good function, and no suprascapular nerve complications.

CONCLUSIONS

The Neviaser portal provides a safe anatomical corridor for percutaneous antegrade humeral nailing, and early clinical experience supports its feasibility; comparative studies are required to establish functional benefit.