Ofer Levy1. 1. Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire RG1 5AN, United Kingdom. E-mail address: oferlevy@readingshoulderunit.com.
Abstract
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.IndicationsContraindicationsPitfalls & Challenges.
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.IndicationsContraindicationsPitfalls & Challenges.
Authors: Sumant G Krishnan; Richard J Hawkins; John D Michelotti; Robert Litchfield; R Baxter Willis; Young Kyu Kim Journal: Clin Orthop Relat Res Date: 2005-06 Impact factor: 4.176