Posterior Approach - Shoulder

Indication

Posterior approach for posterior fracture dislocation involving anatomical neck

Sometimes it is possible to reduce the head from the back percutaneously, Do your usual anterior approch you will use for fixation.

Insert a ring handled spike percutaneously from posterior (in a similar place to the posterior arthroscopic portal), lever it between the head and the glenoid to overcome the engagement of the head with the posterior lip and push the head back into the glenoid.

If not possible to do percutaneously proceed below to open it formally.

Anatomy

Considerations

Positioning

Lateral decubitus position

Skin Incision

Superficial dissection

Split posterior deltoid in line with its fibres (protect the axillary nerve as it emerges from the quadrangular space).

Deep dissection

Dissect the interval between infraspinatus and teres minor muscles exposing the posterior capsule.

Incise capsule vertically.

Insert two slightly curved elevators into the glenoid cavity above and below the humeral head.

Apply longitudinal traction with arm in adduction, gently  forcing the two elevators to join  each other, levering the head back into the glenoid.

The humeral head normally spontaneously reduces once the engagement of the posterior lip is overcome.

Post reduction consider internal fixation in:

• A completely detached humeral head to stabilize the fragment and facilitate revascularization.

• Displaced bone fragments of >1 cm after reduction.

Exposure extension

Closure

Post operatively

References

Personal observations

Page created by: Lee Van Rensburg

Last updated 11/09/2015