BACKGROUNDThe neurovascular alignment in the humeral greater tuberosity (HGT) region has not been thoroughly investigated. However, many studies have documented the vascular-nerve architecture of the proximal humerus. The purpose of this study was to identify novel safety zones on the bony-en-face view of the HGT for surgical procedures.METHODSEighteen complete adult fresh-frozen cadavers (36 paired shoulders) were dissected in this study (12 males and 6 females; mean age of 69.39 years). Five landmarks-A, B, C, D, and E-were established to define the boundary of the HGT. Point A was the intersection of the superior facet of HGT and the intertubercular groove of the long head of the biceps tendon (LHBT). Point B was the junction of the attachment point between the supraspinatus and the infraspinatus muscle. Point C was the intersection of the infraspinatus and the teres minor muscle, and point D was the lowest foot point of the teres minor muscle. Point E was on a vertical intersection line from point D to point A. Next, we segmented the individualized pentagon ABCDE into 15 zones. First, we drew line BF to ensure it was perpendicular to DE. Then, we designated points H, J, and M as the midpoints of the supraspinatus, infraspinatus, and teres minor, respectively, with H and J perpendicular to DE and M perpendicular to EA. Finally, we drew perpendicular lines from points J, C, and M to EA, which intersected at points K, G, and L, respectively.The neurovascular structures in each zone were identified to enable the calculation of percentages, allowing for the definition of safe and dangerous zones.RESULTSWe have identified the specific ranking of the safe zones for branches of the circumflex humeral artery (bCHA) as follows: 1a (19.44%, meaning blood vessels were observed in 7 out of 36 shoulders, accounting for 19.44% of the total), 3a (25%), 2a (47.22%), 7 (66.66%), 2b (75%), 1b (77.77%), 3b (80.55%), 4, 10 and 11(all, 88.88%), 6 and 8 (both 91.67%), 5, 9 and 12 (all, 100%). The specific zone ranking of vascular-branch numbers is as follows: 1a<3a<2a<7 <2b<1b<10<3b<4<6<11< 8< 9<12<5. The specific ranking of the dangerous zones for the anterior branches of the axillary nerve (ABAN) is: 8 (5.55%), 11 (8.33%), 10 (38.88%), and 9 (66.66%).CONCLUSIONWe demonstrate the neurovascular distribution in the 15 zones on the bony-en-face view of the HGT, clearly highlighting both safe and dangerous zones. We recommend following clinical suggestions based on our anatomical findings: (1) Selection of safe insert points from zones 1a, 3a, 2a, or 7 for screw fixation(Liu-Gang Type I & II). (2) Avoidance of neurovascular dangerous zones 8, 11, 10, and 9 for plate fixation. However, we should keep in mind that this technique cannot prevent vascular disruption in these areas.