surgical approaches around the shoulder for trauma se aldridge jan 2008 se aldridge jan 2008
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Surgical Approaches around the Shoulder for
Trauma
Surgical Approaches around the Shoulder for
Trauma
SE AldridgeJan 2008
SE AldridgeJan 2008
Indications for operative intervention
Indications for operative intervention
Clavicle fractureGlenoid neck fractureProximal HumerusIM nailing of diaphyseal humerus
Clavicle fractureGlenoid neck fractureProximal HumerusIM nailing of diaphyseal humerus
ClavicleClavicle
Subcutaneous boneDirect approachDangers:
Neurovascular structures at risk from screw placement
Subcutaneous boneDirect approachDangers:
Neurovascular structures at risk from screw placement
AC JointAC Joint
Direct superior approach
For ACJ dislocation dissection often already done by injury.
Direct superior approach
For ACJ dislocation dissection often already done by injury.
Proximal HumerusProximal Humerus
Treatment options:Non-operativeClosed reduction + internal
fixationOpen reduction + internal
fixationHemiarthroplasty
Treatment options:Non-operativeClosed reduction + internal
fixationOpen reduction + internal
fixationHemiarthroplasty
Approach to Prox HumerusApproach to Prox Humerus
DeltopectoralORIFHemiarthroplasty
Deltoid splittingNailMIPPO
PercutaneousTuberosity fractures
DeltopectoralORIFHemiarthroplasty
Deltoid splittingNailMIPPO
PercutaneousTuberosity fractures
Deltopectoral ApproachDeltopectoral Approach
Positioning:Beach chair
FluoroscopyAccess
Positioning:Beach chair
FluoroscopyAccess
DeltopectoralDeltopectoral
DangersMusculocutaneous nerve
coracobrachialis 5-8cm
Axillary nerveinferior to subscap
DangersMusculocutaneous nerve
coracobrachialis 5-8cm
Axillary nerveinferior to subscap
Deltoid splittingDeltoid splitting
Positioning:Beach chair
Indication:Tuberosity fracturesIM nailingMIPPO (consider lateral position)
Positioning:Beach chair
Indication:Tuberosity fracturesIM nailingMIPPO (consider lateral position)
Deltoid splittingDeltoid splitting
QuickTime™ and aTIFF (LZW) decompressor
are needed to see this picture.
Deltoid splittingDeltoid splitting
Dangers:Axillary nerve
7cm below tip of acromion
Dangers:Axillary nerve
7cm below tip of acromion
MIPPOMIPPO
Deltoid splitting:Blunt Dissect undersurface of deltoid distallyPalpate axillary nerve superficiallyDistal incision over humerusConnect tunnel
Deltoid splitting:Blunt Dissect undersurface of deltoid distallyPalpate axillary nerve superficiallyDistal incision over humerusConnect tunnel
Glenoid and Scapula NeckGlenoid and Scapula Neck
Posterior approach:Lateral Decubitus Position
Posterior approach:Lateral Decubitus Position
QuickTime™ and aTIFF (LZW) decompressor
are needed to see this picture.
Posterior ApproachPosterior Approach
Dangers:Axillary N. + P. circumflex humeral
art.Quadrangular space
Radial NerveTriangular space
Suprascapular N. + Circumflex Scapular vessels
Scapula neck
Dangers:Axillary N. + P. circumflex humeral
art.Quadrangular space
Radial NerveTriangular space
Suprascapular N. + Circumflex Scapular vessels
Scapula neck
Other approachesOther approaches
Anterolateral:Transverse incisionDeltoid either split or reflected
from its origin
Arthroscopy
Anterolateral:Transverse incisionDeltoid either split or reflected
from its origin
Arthroscopy
More informationMore information
www.aofoundation.org/portal/wps/portal/surgery
Information on decision making about treatment ,approach and setup.
Surgical Exposures in Orthopaedics. The Anatomic Approach. - Hoppenfeld
www.aofoundation.org/portal/wps/portal/surgery
Information on decision making about treatment ,approach and setup.
Surgical Exposures in Orthopaedics. The Anatomic Approach. - Hoppenfeld