Thursday, October 16, 2014

Ream and run, variations in glenohumeral anatomy as revealed by plain films (no CT needed)

A 50 year old male who is otherwise healthy and leads an active lifestyle had the insidious onset of right shoulder pain, stiffness and crepitus. Because of his young age and high activity level, he desired a ream and run procedure.

His preoperative AP and axillary xrays revealed a downsloping and retroverted glenoid with a posterior contact position of the humeral head on the glenoid.

At surgery no attempt was made to change his glenoid version or inclination; reaming was limited to that sufficient to provide a smooth, congruent glenoid surface. His postoperative films demonstrated centering of the humeral head on the reamed glenoid socket.

This case also demonstrates that the humeral canal is not a cylinder, but in fact is oval shaped. From the AP xrays the stem appears to have extra room within the canal, while on the axillary lateral xray it has a tight intramedullary fit. Determining the prosthetic stem diameter from the AP x-ray view may lead to selection of a too large prosthesis that will not fit safely in the canal. As demonstrated in this case impaction grafting can manage this anatomy and provide a snug fit.

Case submitted by Robert Lucas


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