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Deltopectoral approach for shoulder arthroplasty: anatomic basis

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Abstract

Purpose

The deltopectoral approach is a common surgical procedure for shoulder arthroplasty. Many surgeons are familiar with this procedure, but certain steps are still controversial. This is the case for the management of subscapularis, where surgeons must choose between tenotomy and the lesser tuberosity osteotomy.

Methods

This article is conceived as a toolkit for the inexperienced surgeons, describing our tips and tricks to facilitate final exposure of the glenoid. For experienced surgeons, we analysed the tricky portions of the deltopectoral approach, comparing them with what is classically reported in the literature.

Results

We describe an original technic for subscapularis reattachment after lesser tuberosity osteotomy in order to improve its stability. The medial part of the fragment is secondarily sculpted to obtain a step shape, which will be applied against the base of the prosthetic cup in a sort of “corner buttress”.

Conclusions

Our work, based on our personal experience, confirms that there is no preferred single deltopectoral approach but, rather, multiple options. When embarking on this “shoulder highway”, we encourage surgeons to respect the successive anatomic planes, which we believe is the only way to ensure easy and atraumatic dissection.

Key points

- The safe plane for going around the humeral head and positioning retractors is the plane of the subacromial deltoid bursa.

- Always stay close to the bone during capsule release, whether on the humeral or glenoid side.

- Never go medially to the conjoint tendon or its deep face.

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Authors and Affiliations

  1. Tours University Hospital Center, Orthopaedics and Trauma I, François Rabelais University, Trousseau Hospital, Tours, France

    Francois Gadea, Yves Bouju, Julien Berhouet, Guillaume Bacle & Luc Favard

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  1. Francois Gadea
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Correspondence to Francois Gadea.

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Gadea, F., Bouju, Y., Berhouet, J. et al. Deltopectoral approach for shoulder arthroplasty: anatomic basis. International Orthopaedics (SICOT) 39, 215–225 (2015). https://doi.org/10.1007/s00264-014-2654-x

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