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CASE REPORT

Harborview Medical Center

University of Washington Medicine

19

(P: 211511) If you choose Open reduction internal fixation (ORIF), what surgical approach would you use?

I would not choose ORIF

2%

6/222

Modified (mini-open) Judet

32%

73/222

Extensile Judet approach

39%

87/222

Deltopectoral

9%

21/222

Mini-open + Deltopectoral

3%

7/222

Extensile + Deltopectoral

4%

9/222

Outside of my area of expertise - best if I don't vote

8%

19/222

I think the hardest thing about these cases is visualization and identifying the correct muscles. The Judet approach works well but most people still find it very challanging to finding the correct interval, whether it is Supra/infra or infra/teres minor. And no one wants to destroy/injure these cuf...f muscles.To me the biggest thing is identifying the entire posterior deltoid so you effectively retract it superiorly (using a bankart on the scapular spine). Once you have done this, the insertions of the infra/TM are much easier to recognize. Jonah Davies whats your biggest judet pearl?

Looks really good well done. I think it was the perfect one to fix as the glenoid was unstable and displaced and given it was a poly trauma it’s one where fixing it will really held with rehab and permit earlier assisted weight bearing with aids.

Scapular y primarily but can be obtained easily in lateral position. You can drill under fluoroscopic visualization alternating grashey to scapular y leaving drill bit in. It helps to palpate the Coracoid with your non dominant hand while drilling

Jan S. sloppy lateral with blanket rolls on either side of the patient. C arm coming in from contralateral side.

This is an interesting situation. I think in isolation this could potentially be treated without surgery, although stiffness would be a problem because it would probably be hard to get her moving early. In the poly traumatized situation like this I think it should probably be fixed to aid mobilizati...on. As to how to fix it I would defer to my partners that do this stuff. I have retired from the scapula game.