Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Instability of the Shoulder: Complex Problems and Failed Repairs. Part II.

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Presentation transcript:

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Instability of the Shoulder: Complex Problems and Failed Repairs. Part II. Failed Repairs*† by EVAN L. FLATOW, ANTHONY MINIACI, PETER J. EVANS, PETER T. SIMONIAN, and RUSSELL F. WARREN J Bone Joint Surg Am Volume 80(2): February 1, 1998 ©1998 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A and 1-B: A patient who had recurrent anterior glenohumeral instability after a previous repair for instability. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-B: Intraoperative photograph showing the Bankart lesion (arrowhead). EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Arthrographic computerized tomography scan of a shoulder, showing failed correction of a large, redundant inferior capsular pouch. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-A through 3-D: An active young male patient who had recurrent dislocation after three previous failed repairs for instability. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B Axillary radiograph showing loss of about one-third of the anteroinferior portion of the glenoid. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-C: Anteroposterior radiograph, made at the revision reconstruction, showing anteroinferior placement of graft. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-D: Axillary radiograph made after the coracoid transfer. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4 Photograph of a patient demonstrating loss of external rotation after a Putti-Platt repair for recurrent instability. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5 Radiograph showing damage to the articular surface from loose or misplaced hardware. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Figs. 6-A and 6-B: Drawings showing arthroplasty for treatment of arthrosis after an overly tight repair for the treatment of anterior instability. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-B Repair of the subscapularis to the anatomical neck, medial to its original insertion, also functionally lengthens the tendon. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Figs. 7-A through 7-G: A female patient with secondary arthrosis after a Bristow procedure who had a very stiff shoulder, constant pain, and very little use of the upper extremity. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-B Axillary radiograph showing posterior subluxation of the humerus with eccentric posterior wear of the glenoid. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-C Anteroposterior radiograph made after a total shoulder replacement. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-D Axillary radiograph, made after the total shoulder replacement, showing proper positioning of the component and partial restoration of normal glenoid version. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Figs. 7-E, 7-F, and 7-G: Photographs made one year after the shoulder replacement and soft- tissue rebalancing. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-F Full external rotation. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-G Full internal rotation. EVAN L. FLATOW et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.