Wednesday, June 18, 2014

Ream and run for severe post fracture deformity

Some of the toughest shoulder joint replacement cases are for shoulders in active folks who have previously sustained a fracture. Here are the films of such a case that we operated yesterday - a very active man from the opposite corner of the U.S. with severe deformity and arthritis after a fracture with malunion of the tuberosities and humeral head. On examination he had no glenohumeral motion. He wanted a ream and run so he could return to activities without restriction. No CT scan was obtained.

The surgery required an in situ osteotomy because it was impossible to dislocate this locked up joint.
His glenoid and humeral head were grossly deformed. An anteriorly eccentric humeral head was required to cover the anteriorly malunited fracture. The humeral stem was fixed with impaction grafting.

On the morning after surgery he demonstrated 130 degrees of assisted elevation and stated he'd be able to get more by the afternoon.


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