Introduction This article describes our technique of thoracoscapular fusion with screw fixation for treatment of winging of the scapula in patients with fascioscapulohumeral dystrophy.
Step 1: Preoperative Evaluation Perform the Horwitz test.
Step 2: Position the Patient and Mark the Skin for the Operation With the patient on a Montreal mattress, position the arms in 90° to 110° of elevation in the scapular plane and approximately 90° of external rotation and mark the skin.
Step 3: Surgical Approach Make an incision along the medial scapular edge, incise the trapezius muscle, and detach the levator scapula, rhomboid major, and rhomboid minor muscles.
Step 4: Prepare the Scapula Do not decorticate the scapula to avoid weakening it.
Step 5: Select and Prepare the Ribs Expose three or four ribs subperiosteally, from their superior border to avoid the neurovascular bundle.
Step 6: Drill the Scapula and Ribs Drill the ribs with a McDonald dissector underneath them to prevent damage to the pleura.
Step 7: Harvest and Introduce Bone Graft, or Use Bone-Graft Substitute, and Close Pack bone chips or bone-graft substitute between the ribs and the deep surface of the scapula.
Step 8: Postoperative Immobilization and Rehabilitation An adjustable brace with the arm in 60° of abduction and 30° of forward flexion is worn for three months.
Results Between July 1997 and July 2010, a thoracoscapular fusion was performed in thirty-five shoulders of twenty-four patients with fascioscapulohumeral dystrophy15.
Pitfalls & Challenges
This article describes our technique of thoracoscapular fusion with screw fixation for treatment of winging of the scapula in patients with fascioscapulohumeral dystrophy. Winging of the scapula may be caused by dysfunction of the long thoracic nerve with a resultant anterior serratus muscle palsy and/or trapezius palsy due to spinal accessory nerve injury. This can be caused by …
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