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How to do a posterior acromial pediculated bone block technical note on the arthro-Kouvalchouk device

Published in N°271 - February 2018
Article viewed 374 times

How to do a posterior acromial pediculated bone block technical note on the arthro-Kouvalchouk device

By Pierre Métais (1) – Jean Grimberg (2) in category TECHNIQUE
(1) - ELSAN, Hôpital privé La Châtaigneraie, 63110 Beaumont, France / (2) - IRCOS, 6 avenue Alphonse XIII, 75016 Paris, France

Posterior instability is an uncommon pathology, and may be atraumatic or traumatic. It is important to be able to recognize it on methodical clinical examination. First-line treatment is still physiotherapy that aims to realign the humeral head both passively and actively.

Introduction

Posterior instability is an uncommon pathology, and may be atraumatic or traumatic (Fig. 1). It is important to be able to recognize it on methodical clinical examination. First-line treatment is still physiotherapy that aims to realign the humeral head both passively and actively.

Fig. 1 : A push on the arm leads to posterior translation of the humeral head during a hand-off

 

Should functional treatment fail, if there are substantial anatomical lesions and in the absence of adverse psychological factors, surgical treatment is suggested to deal with capsulo-labral and potential bone lesions: capsulo-ligamentous repair (1-3), McLaughlin remplissage of the anterior notch (4-5), iliac bone block (6-11) and so on.

Pediculated acromial bone block with a deltoid flap was described by Kouvalchouk (12). It meets the same mechanical needs as Patte and Latarjet’s coracoid bone block does for anterior instability (13-15). It allows the shoulder to be ‘double-locked’ by means of bone augmentation and a muscular sling effect. The glenoid fossa is ‘rebuilt’ or augmented, and the joint capsule strengthened. A ‘triple lock’ may be added via reinsertion of the capsule on the posterior rim of the glenoid.

Arthroscopy (Fig. 2) opens up new options during this type of surgery and...

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