Operative Technique
Shoulder Hemiarthoplasty for Trauma
Aims
Indications
- complex fractures / dislocations
- split fractures with 3-4 fracture fragments
- dislocation fractures
- compression fractures with destruction of >50% of the articular surface
Contraindications
Consent / Preop Planning
Principles
Options
Position
- Supine
- Beach chair 20°
- Patient placed laterally to obtain good access to shaft and ROM
- (use shoulder table)
- Rigidly fix patient's head
Landmarks
- clavicle, coracoid, AC joint
Incision
Anterior deltopectoral approach
Start
- edge of clavicle above the coracoid process
End
- humeral insertion of deltoid
Internervous Plane
- Deltoid
- Pectoralis major
Superficial Dissection
- Locate cephalic vein and mobilise medially
- incise clavipectoral fascia
- Idntify conjoint tendon ( short head of biceps and coracobrachialis) and retract medially
Deep Dissection
Dangers
Nerves
- Musculocutaneous Nerve
Vessels
- Cephalic Vein
Procedure
- Identify Fracture fragments
- Localised distally the tendon of long head of biceps
- follow it proximally up to the rotator interval
- Greater tuberosity is lateral
- Lesser tuberosity is medial
- follow it proximally up to the rotator interval
- Remove humeral head
- Expose diaphyseal stump
- external rotation and extension
- Ream until correct stem is found
- Remove impactor leaving the stem inplace
- Insert a trial humeral body
- short, medium, long
- check retroversion,
- secure with screw, allen wrench, body stopper
- Trial Humeral Heads
- Adaptors : standard or long | neutral or eccentric
- Head sizes :
- determined by head gauge on resected head
- Reduce implant
- check contact with glenoid
- Take note of body insertion depth before removing trials
- Insert definitive stem
Postop / Rehab
Results
Complications / Dangers
Perioperative
General
Local
Postoperative
Early
Late
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