Abstract
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Introduction
The most difficult part of shoulder replacement
Important steps
Anaesthesia and patient position
Soft-tissue releases
Humeral bone removal
Retractor placement
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Anaesthesia and Patient Position
Need full paralysis
Patient must be positioned laterally enough so that the scapula is unsupported
Arm is draped free so that it can be manoeuvred to find the position of optimal glenoid visualisation – usually this is slight extension, external rotation, and GH elevation to 45 – 60°
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Soft-tissue Releases
Humeral side – make sure that the rotator interval is incised all the way to the glenoid margin and that the inferior capsule is released past the six o’clock position
Glenoid
Circumferential labral excision
Circumferential capsular release
Check for biceps glide
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Humeral Bone Removal
Remove all osteophytes – inferior, anterior, and posterior
Make sure humeral osteotomy is through anatomic neck so that there is minimal bone protruding beyond the humeral cuff reflection
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Retractor Placement
Retractors needed
Ring retractor (e.g., Fukuda) – both small and large
Other types of humeral head retractors (e.g., Carter Rowe)
Reverse Homan x2
Single prong Bankart retractor
Large flat retractor (e.g., Darrach)
Placement
Fukuda or Carter Rowe retractor – within the joint, levering on the posterior glenoid to displace humeral head posteriorly
Large Darrach – on anterior neck of scapula retracting subscapularis
Single prong Bankart or reverse Homan – superior glenoid under biceps anchor
Reverse Homan – inferior glenoid. Not always necessary.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.