Shoulder Instability: Reconstruction of Bone Loss at Shoulder Socket With Bone Graft and Screws

Shoulder Instability: Reconstruction of Bone Loss at Shoulder Socket With Bone Graft and Screws

This cadaveric video demonstrates the reconstruction of the front portion of the socket with bone on a right shoulder. This procedure involves transferring bone from another part of the shoulder, the coracoid process, to restore the shape of the socket and can help restore stability to the shoulder joint.

This procedure, referred to as a Latarjet, may be considered for patients who have sustained multiple shoulder dislocations or had a previous labral repair surgery but now have lost bone on the front part of the shoulder. Here, we see a right cadaveric shoulder. We are looking at the front portion of the shoulder and can see that the surgeon has drawn out important landmarks along with the planned incision represented by the dotted line.

The skin incision is made, and the soft tissue is dissected until the front rotator cuff tendon, the subscapularis, is reached. The surgeon will make an incision in the muscle and joint capsule to gain access to the shoulder joint. Instruments are then placed in the joint to help the surgeon see better. Now, the surgeon can see the front portion of the socket where the bone loss has occurred.

The surface of the front part of the socket is prepared to accept the bone graft later in the case. Next, the surgeon will harvest bone from another part of the shoulder, called the coracoid process. Once this bone is removed from its normal location, the surgeon will shape it to fit onto the front of the shoulder socket.

Once shaped, the surgeon will attach a clamp to the bone block. This clamp has holes which will be used as a guide to prepare two holes in the top and bottom of the graft for screw placement later in the surgery. A different guide is then applied to the bone graft after it has been prepared. This guide will help the surgeon position the bone graft onto the front of the socket in the proper position and pin it into place.

The surgeon will then use a drill over the pins to prepare holes in the socket in the same position as the graft top to bottom. That way, once the screws are placed, they secure the graft and socket together as planned. The screws are then placed, and the reconstruction is complete. After the reconstruction of the socket, the capsule and subscapularis will be repaired along with the rest of the soft tissue and skin.