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GLENOID EXPOSURE & RETRACTOR PLACEMENT: GETTING IT RIGHT



Abstract

  1. Introduction

    • The most difficult part of shoulder replacement

    • Important steps

      1. Anaesthesia and patient position

      2. Soft-tissue releases

      3. Humeral bone removal

      4. Retractor placement

  2. 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°

  3. 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

      1. Circumferential labral excision

      2. Circumferential capsular release

      3. Check for biceps glide

  4. 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

  5. Retractor Placement

    • Retractors needed

      1. Ring retractor (e.g., Fukuda) – both small and large

      2. Other types of humeral head retractors (e.g., Carter Rowe)

      3. Reverse Homan x2

      4. Single prong Bankart retractor

      5. Large flat retractor (e.g., Darrach)

    • Placement

      1. Fukuda or Carter Rowe retractor – within the joint, levering on the posterior glenoid to displace humeral head posteriorly

      2. Large Darrach – on anterior neck of scapula retracting subscapularis

      3. Single prong Bankart or reverse Homan – superior glenoid under biceps anchor

      4. 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.