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Deltopectoral Approach to the Shoulder
Lennard Funk Manchester
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Utility Approach
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Suitable for:
1. Arthroplasty 2. Anterior Stabilisation procedures 3. Proximal Humeral Fractures 4. Glenoid Fractures 5. Combined procedures
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Not Suitable for:
1. Rotator Cuff Surgery 2. Posterior Stabilisations 3. AC Joint
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Advantages
• Potential for extension • Exposure • Little bleeding (betw. Muscle planes) • Internervous plane
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Disadvantages
• Difficulty exposing glenoid • Access to greater tuberosity & Cuff
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Preparation
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Instruments
• Retractors – Norfolk-Norwich – Richards – Gelpi – Kolbel
• Humeral Head Retractors – Fukuda – Skid
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Position Head & Neck Secured
Knees bent 30 degrees Scapula Wedge
Arm free
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Incision
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Cephalic vein
Radkowski et al. An Anatomic Study of the Cephalic Vein in the Deltopectoral Shoulder Approach. CORR. 442:139-142, January 2006.
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Coracoid is the ‘lighthouse’ to the shoulder
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Subdeltoid & Subpectoral Spaces
thoracoacromial artery
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Clavipectoral Fascia
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Axillary & Musculocutaneous Nerves
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Musculocutaneous Nerve
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Anterior Circumflex
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Subscapularis
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Anterior Capsule
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Extensions
• Inferior: – pec major release – Medial deltoid from clavicle superiorly
• Superior: – Detach Deltoid from acromion – Clavicle osteotomy
• Medial – Conjoined tendon release
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Pec major & Conjoined Tendon Releases
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Clavicle Osteotomy
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Clavicular Osteotomy
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Combined Approach
Levy et al. JSES 1999
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THANK YOU
Images courtesy of: – Operative Shoulder Surgery – Copeland – Primal Pictures – Lars Neumann, Nottingham
Presentation published in the Education Section at www.shoulderdoc.co.uk
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