Sunday, March 3, 2013

Reverse total shoulder, careful with the screws!

Glenoid screw position in the Encore Reverse Shoulder Prosthesis: an anatomic dissection study of screw relationship to surrounding structures

This study points to the potential for the drill and the fixation screws of the reverse total shoulder to contact and injure nerves around the shoulder. 

The risk of nerve injury is related to (1) the orientation (superior/inferior position, anteversion/retroversion, superior/inferior tilt, rotational alignment) of the baseplate: for example tilting the glenosphere inferiorly (as recommended in the technique guide) increases the risk of drill and screw encounters with the suprascapular nerve, (2) the size of the glenoid bone, (3) avoiding drilling beyond the far cortex (plunging) and (4) avoiding excessive screw length.

Although the authors have suggested safe lengths for the different screws, these screw lengths were determined with idealized glenosphere placement in normal scapulae and are not clinically applicable to the shoulders having reverse total shoulders. 

Careful surgical technique and awareness of the risk of nerve injury are important in avoiding these problems


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