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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
PROSTHESIS ON FRACTURES GLENOHUMERAL FRACTURES. SYNTHESIS, PROSTHESIS,ARTHROSCOPY: A COMPARISON OF DIFFERENT TECHNIQUES
Minerva Ortopedica e Traumatologica 2006 August;57(4):321-7
The role of anatomic reconstruction in the surgical technique of the hemiarthroplasty
Caresio M., Indemini E., Lancione V., Larosa G.
1 Casa di cura “Villa Igea” Dipartimento di Ortopedia, Acqui Terme
2 Clinica Ortopedica Università degli Studi di Genova, Genova
Aim. The Grammont inverse prosthesis is successfully used in glenohumeral arthropathies associated with rotator cuff lesions, enabling restoration of active shoulder motion. A limitation to this system, however, is the lack of recovery of external rotation when the teres minor muscle is also injured. In such cases the use of combined inverse prosthesis and transfer of the latissimus dorsi via the pectoral deltoid approach is recommended. The results of a series of 5 patients treated with this technique and followed up for 22 months are presented. Methods. From March to November 2004, 5 patients (mean age, 76.2 years) with arthropathy caused by rotator cuff injury (and confirmed teres minor lesion) received a Grammont inverse prosthesis combined with transfer of the latissimus dorsi via the deltoid-pectoral approach.
Results. The Constant Score (maximum 100) increased an average of 36.4 points (from 26.8 to 63.2). The significant improvement in extrarotation at 22 months of follow-up permitted all patients to resume tasks of daily living such as grooming and lifting objects over the head.
Conclusions. Combined transfer of the latissimus dorsi and the Grammon inverse prosthesis provides partial restoration of external rotation in abduction in patients with arthopathy due to rotator cuff injury and positive clarinet sign. The advantages of the technique are: single deltoid-pectoral approach, reproducibility, complication rate comparable with isolated prosthesis implantation with the same system.