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Disclosure
- Zimmer-Biomet: Royalties
Glenoid Exposure Tips and Tricks to Achieve Reproducible Glenoid - - PowerPoint PPT Presentation
Glenoid Exposure Tips and Tricks to Achieve Reproducible Glenoid - - PowerPoint PPT Presentation
Glenoid Exposure Tips and Tricks to Achieve Reproducible Glenoid Access John W. Sperling, MD, MBA Mayo Clinic Disclosure Zimmer-Biomet: Royalties Positioning Beach chair position Waist 45 , knees 30 Slightly roll the
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Positioning
- Beach chair position
–Waist 45°, knees 30° –Slightly roll the body away from the
- perative shoulder
–Place a rolled up towel under the medial border of the scapula
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Positioning
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Approach
- Landmarks
–Posterior spine of the scapula –Lateral/Anterior border of the acromion –Clavicle –Coracoid
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Approach
- Incision
–Begins at the anterior portion of the clavicle –Passes approximately ½ cm lateral to the coracoid
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Approach
- Incision
–Develop the deltopectoral interval proximally – Small triangle of fat is usually present identifying the infraclavicular triangle –Vein is left medially
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Deltoid Mobilization
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Incise Interval-Subscapularis
- Identify the rotator interval
- Significant surgeon variability in technique
- f releasing the subscapularis
– Intra-tendinous – Off bone – Osteotomy
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Marking Stitches
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Inferior Capsule
- Inferior capsule release: stay on bone and
directly visualize the capsule
- Arm externally rotated and adducted,
continue the release to the 4 o’clock position
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Open the Door
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Complete Inferior Release
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Humeral Head Cut
- Use a drill to gain access to humeral canal
- Prepare humeral canal with hand reaming
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Entry Hole
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Ice Pick
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Reamer
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Humeral Head Cut
- Cutting block is 1 mm above RC insertion
- 30-35° retroversion is average
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Humeral Guide
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Head Cut
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Humeral Preparation
- Seat broach
- Trim away
metaphyseal bone
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Complete Osteophyte Removal
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Glenoid Exposure
- Common reasons for difficult exposure
–Lack of deltoid mobilization –Insufficient capsular release –Too high a head cut –Insufficient humeral osteophyte removal
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Retractors
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Glenoid Exposure
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Glenoid Exposure
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Glenoid
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Glenoid
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Glenoid
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Glenoid
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Glenoid
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PSI
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PSI
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PSI
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Summary
- Key to glenoid exposure is the humeral
side
- When in doubt-repeat the 4 key steps
– Aggressive humeral head cut – Humeral osteophyte removal – Inferior capsule – Deltoid mobilization
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