Subscapular and Pectoralis Major Sparing Deltopectoral Approach for Reverse Total Shoulder Arthroplasty

In reverse ball shoulder replacement, surgery is usually performed using a deltopectoral approach or an anterosuperior transdeltoid approach. The deltopectoral approach is to incise the pectoralis major to upper 1/3 to 1/2, and subscapularis tendon should be removed at the lesser tuberosity of the humerus. This approach has the problem of breaking the shoulder deltoid instead of incising the rotator cuff. Therefore, we report a detailed procedure of reverse ball shoulder replacement using approach without incision of the pectoralis major muscle and subscapularis muscle.

Difference in the Surgical Approach in Reverse Total Shoulder Arthroplasty for Cuff Tear Arthroplasty: Comparison of the Radiological and Clinical Result according to the Deltopectoral and Anterosuperior Approach / 대한정형외과학회잡지

PURPOSE: This study compared the clinical and radiological results of reverse total shoulder arthroplasty (RSA) using an anterosuperior approach with those using a deltopectoral approach to determine the difference in cuff tear arthroplasty between both approaches. MATERIALS AND METHODS: A retrospective review of 24 consecutive patients who underwent RSA due to cuff tear arthroplasty from February 2014 to November 2015 was performed. The anterosuperior and deltopectoral approaches were 12 cases each. The mean age was 72 years and the mean follow-up period was 13.2 months. The clinical results were assessed using the visual analogue pain scale, American Shoulder and Elbow Surgeon score, Korean shoulder scoring system, and the Constant score. The prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenosphere rim distance (inferior glenosphere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance were assessed, and severity of notching according to the Nerot-Sirveaux classification, were measured from the radiology evaluation. RESULTS: Compared to the anterosuperior approach, the PSNA (9.6°, p=0.018) and inferior glenosphere overhang (2.0 mm, p=0.024) were significantly greater in the deltopectoral approach and the PGRD (2.2 mm, p=0.043) was shorter. The AT and GT distance was similar in the two groups. Two and three cases of implant notching occurred on deltopectoral approach and anterosuperior approach, respectively. No metal loosening, acromion fracture, or nerve injury was noted. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. CONCLUSION: The anterosuperior approach could cause the superior position of the glenoid baseplate and a decrease in the inferior tilt compared to the deltopectoral approach, but the clinical results had improved in both groups and there was no difference between the two groups.

Clinical study of two approaches for the treatment of proximal humerus fractures / 中国综合临床

Objective To evaluate the effect of locking plate in the treatment of proximal humerus fractures and to compare the results of two approaches used for fixation.Methods Surgical treatment of 47 cases of proximal humerus fractures in the elderly in Affiliated Hospital of Yan′an University from September 2014 to September 2015.All fractures were randomly divided into two groups and treated with Phlios plate.Deltoid splitting and deltopectoral approaches were used for fixation respectively 23 cases and 24 cases.Postoperative shoulder function was evaluated according to Neer Score.Results The operation time,length of incision,intraoperative bleeding,fracture healing time,length of hospitalization in thoracic deltoid muscle group were more than deltoid splitting pathway group((90.1±6.3) min vs.(73.0±9.5) min,(10.0±3.5) cm vs.(6.3±2.6) cm,(100.0±30.1) ml vs.(90.6±36.4) ml,(3.2±0.8) months vs.(3.0±0.7) months,(10.3±1.9) d vs.(10.1±1.9) d),the difference of operation time(t=2.133,P=0.042) and length of incision(t=2.236,P=0.036) was statistically significant between the two groups,while the difference of the intraoperative bleeding(t=1.867,P=0.063),fracture healing time(t=1.064,P=0.242) and length of hospitalization(t=0.667,P=0.256) were not statistically significant.Followed up for 6.0-12.0 months,the average was (9.0±2.0) months,all patients achieved the bony healing.During the followed up,5 complication(10.6%) were encountered,including 2 cases of varus malunion,1 case of acromial impingement(115°-124°),1 case of screw cut-out and 1 case of humerus head osteonecrosis.The patients with tow-or three parts fractrues in tow groups,Neer-Score scores were statistically significant ((76.8±2.8) points vs.(76.1±2.6) points,(78.9±2.3) points vs.(77.8±2.4) points,t=2.76,2.58,P0.05).The excellent-good rate in triangle muscle splitting approach group was 91.3%(21/23),of thoracic deltoid muscle group was 58.3%(14/24),there were significant different existed in two groups(P=0.023).Conclusion Locking plate for the treatment of proximal humerus fractures has a good effect.Deltoid splitting approach in the prognosis of function recovery has more advantages.

Study of operative management for complex fracture of upper end of Humerus.

Background: Proximal humerus fractures are very common fractures occurring in the skeleton. They account for approximately 4 – 5% of the fracture attendance at the hospital. It is the most common fracture of shoulder girdle. It is the 3rd most common fracture in elderly. Till date various methods are used including percutaneous and open reduction & fixation according to fracture type. Aims & Objective: To study the occurrence, mechanism of injury and displacement of various types of fractures and different modalities of the fixations in proximal humerus fractures. Come to conclusion about preferred modality of treatment of proximal humerus fractures according to the pattern of fracture. Material and Methods: In present study 44 patients of complex fracture of proximal humerus treated with either open reduction internal fixation or percutaneous fixation from 2009 to 2012. Follow up assessment was done by Constant score. Results: Radiological union occur at about 8 to 12 weeks. Closed reduction and percutaneous k wire or cancellous screws fixation showed excellent results in majority cases of 3 -part fracture. All 4 part fractures are treated with ORIF. Open reduction and internal fixation with locking compression plates showed good results among all implants used. Conclusion: Principle of fixation is reconstruction of the articular surface, including the restoration of the anatomy, stable fixation, with minimal injury to the soft tissues preserving the vascular supply, should be applied. Majority of poor results are due to poor surgical techniques and lack early physiotherapy.