PRIMA Stem Surgical technique
Introduction
Access There are two recommended surgical
approaches to the shoulder joint. As in every surgical procedure, the access depends on diagnosis, planned surgical procedure and the experience of the surgeon. Shoulder range of motion may be evaluated with the patient under anesthesia to confirm the preoperative assessment and the extent of capsular release needed to restore the ROM postoperatively.
Preoperative planning LimaCorporate products should be implanted only by surgeons familiar with the joint replacement procedures described in the specific surgical techniques. Pre-operative planning, through radiographic templates in different formats, provides essential information regarding the type and size of components to be used and the correct combination of required devices based on the anatomy and specific conditions of each patient. Inadequate pre-operative planning can lead to improper selection of the implants and/or incorrect implant positioning. In selecting patients for surgery, the following factors can be critical to the eventual success of the procedure: the bone stock of the glenoid and humerus must be able to support the implant. In cases with significant bone loss and in which adequate fixation on the glenoid side cannot be obtained, a hemiarthroplasty with a CTA-head should be performed. Positioning Shoulder arthroplasty is normally performed in a “beach- chair” position; the surgeon needs complete access to the shoulder joint. The arm is free or stabilized by arm-holders. The shoulder must be positioned off the edge of the table to afford unobstructed arm extension. The patient’s head must be supported and stabilized in the neutral position. Nerve injury due to brachial plexus traction during positioning and surgery must be avoided. The surgeon must have a complete anterior view of the shoulder and positioning should allow unobstructed movement of the shoulder joint.
Delto-pectoral approach
Anterior vertical incision starts 1 cm later to the coracoid bone, slanting towards the axillary’ pouch. If there is a metaphyseal fracture, slant the incision laterally towards the deltoid insertion at the humerus. The cephalic vein is retracted laterally with the deltoid muscle. The clavipectoral fascia is incised along the lateral edge of the conjoined tendon up to the coracoacromial ligament. A retractor can easily be placed over the superolateral aspect of the humeral head to retract the deltoid. The conjoined tendon is retracted medially. The musculocutaneous nerve penetrates the lateral coracobrachialis muscle 3 to 8 cm distally of the tip of the coracoid process. The position of the axillary nerve should be identified along the anterior surface of the subscapularis muscle, below the conjoined tendon.
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