The modified axial view: an alternative radiograph in shoulder injuries.

Shenton, Ayeshea; Olney, D B

doi:10.1136/emj.4.3.201

Cited by 3 publications

(2 citation statements)

References 1 publication

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“… Reduction is satisfactory if the medial calcar is reconstructed to reestablish the Gothic arch and the greater tuberosity is reduced to 6 to 8 mm below the top of the humeral head. Confirm fracture reduction using true anteroposterior and modified axial fluoroscopic views 4 before applying the plate. …”

Section: Step 7: Reduction Of the Head And Tuberosity Fragments ( mentioning

confidence: 96%

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Locked Plate Fixation of Proximal Humeral Fractures Through an Extended Deltoid Split Approach with Use of a Shoulder Strap Incision

Gavaskar¹,

Tummala²,

Kumar³

et al. 2015

JBJS Essential Surgical Techniques

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OverviewIntroductionThe shoulder strap approach involves an anterolateral deltoid split with use of an inverted U incision, providing excellent lateral exposure for locked plate fixation of complex proximal humeral fractures.Step 1: Positioning of the Patient and the Image IntensifierProper positioning of the image intensifier is important for uninterrupted fluoroscopy.Step 2: Skin IncisionThe tip of the acromion is a useful landmark and serves as the proximal extent of the incision.Step 3: Raise the Distally Based Fasciocutaneous FlapRaise a broad-based full-thickness fasciocutaneous flap.Step 4: Creation of the Proximal Working WindowSplit the deltoid anteriorly to minimize the chances of denervation.Step 5: Identification and Protection of the Axillary NerveLeave a cuff of deltoid muscle to protect the axillary nerve.Step 6: Placement of Traction Cuff SuturesThe cuff sutures are helpful in reduction of the proximal fracture segments and improve stability of three and four-part fractures.Step 7: Reduction of the Head and Tuberosity FragmentsAvoid varus reduction and reestablish the relationship between the humeral head and the greater tuberosity.Step 8: Plate PlacementProper plate positioning is important to maximize the possibility of using all proximal screw options and to minimize chances of impingement.Step 9: Fracture FixationAs is necessary with all locked internal fixators, reduce the fracture before fixing the plate; the order of fixation may vary with the type of fracture.ResultsIn our study of fifty patients with a displaced three or four-part fracture treated with this approach, all flaps healed well without any necrosis and no infections were seen.IndicationsContraindicationsPitfalls & Challenges

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Section: Step 7: Reduction Of the Head And Tuberosity Fragments ( mentioning

confidence: 96%

“…Confirm fracture reduction using true anteroposterior and modified axial fluoroscopic views 4 before applying the plate.…”

Section: Step 7: Reduction Of the Head And Tuberosity Fragments ( mentioning

confidence: 96%