Surgical Approaches around the Shoulder for Trauma SE Aldridge Jan 2008 SE Aldridge Jan 2008.

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

PositionPosition

Beach chairSupineLateral decubitus

Beach chairSupineLateral decubitus

ClavicleClavicle

Subcutaneous boneDirect approachDangers:

Neurovascular structures at risk from screw placement

Subcutaneous boneDirect approachDangers:

Neurovascular structures at risk from screw placement

ClavicleClavicle

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

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


FluoroscopyAccess

DeltopectoralDeltopectoral

DeltopectoralDeltopectoral

DangersMusculocutaneous nerve

coracobrachialis 5-8cm

Axillary nerveinferior to subscap

DangersMusculocutaneous nerve

coracobrachialis 5-8cm

Axillary nerveinferior to subscap

Deltoid splittingDeltoid splitting


Indication:Tuberosity fracturesIM nailingMIPPO (consider lateral position)


Indication:Tuberosity fracturesIM nailingMIPPO (consider lateral position)


QuickTime™ and aTIFF (LZW) decompressor



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


Posterior ApproachPosterior Approach

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

http://www.aofoundation.org/portal/wps/portal/surgery




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Surgical Approaches around the Shoulder for Trauma SE Aldridge Jan 2008 SE Aldridge Jan 2008.

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