Thursday, February 4, 2016

Ream and run, glenoid version and humeral subluxation

There is much discussion and some confusion about the relationship of glenoid version (the angle between the face of the glenoid and the body of the scapula) and the centering of the humeral head on the glenoid. In previous posts (for example here), we have shown that severe posterior decentering can occur without substantial glenoid retroversion and that this pathoanatomy can be managed with a ream and run procedure.

The opposite is also true, as shown in the case below: severe glenoid retroversion can occur without substantial posterior decentering of the humeral head and that this pathoanatomy can be managed with a ream and run procedure.

The AP x-ray does not tell the whole story

But the axillary "truth" view shows the humeral head centered on a severely retroverted glenoid,

In this case the glenoid retroversion measured 40 degrees. 

Two years after surgery, the patient reported that he was "tenfold more capable of enjoying life" than he was 30 months ago.  The healing of his retroverted glenoid is shown in the films below.

There has been no evidence of posterior instability in site of the fact that his glenoid version was not substantially changed by the reaming.


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