Introduction Combined glenoid osteotomy with tendon transfers is a new alternative procedure for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy.
Step 1: MRI or CT for Preoperative Planning Use axial plane MRI or CT for preoperative planning.
Step 2: Surgical Approach with Deltoid Elevation Position the patient laterally, and undertake a posterior approach, including lateral elevation of the deltoid origin.
Step 3: Subscapularis Slide Elevate the subscapularis from the scapula, provisionally reduce the humeral head, and apply gentle external rotation.
Step 4: Harvest of the Teres Major and Latissimus Dorsi Tendons Incise the insertions of the teres major and latissimus dorsi from the proximal part of the humerus and perform a tenolysis.
Step 5: Posterior Approach to the Glenohumeral Joint Open the posterior glenohumeral joint and assess overhead elevation.
Step 6: Assessment and Improvement of Abduction Contracture Improve abduction contracture if it is marked.
Step 7: Harvest of Bone Graft Harvest tricortical graft from the scapular spine or posterior aspect of the acromion.
Step 8: Scapular Neck Osteotomy Undertake a posterior opening wedge osteotomy of the scapular neck.
Step 9: Posterior Opening Wedge at the Osteotomy Site Insert the bone graft into the osteotomy site.
Step 10: Joint Closure and Infraspinatus Repair Close the posterior aspect of the capsule and the infraspinatus.
Step 11: Transfer of the Teres Major and Latissimus Dorsi Transfer the teres major and latissimus dorsi tendons into an osseous trough at the greater tuberosity.
Step 12: Closure and Immobilization Repair the deltoid, close the wound in layers, and apply a shoulder spica cast.
Step 13: Postoperative Plan Maintain the spica cast for five to six weeks; then initiate physiotherapy.
Results In our series of thirty-two patients with severe glenohumeral dysplasia who underwent combined glenoid osteotomy and tendon transfers, early results suggest that …
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