Posterior Capsule

post.capsule
Surgical Technique

Posterior Capsular Repair – Dr. Hawkins

Positioning: Lateral decubitus on the beanbag.

Prepping and Draping:

Shave the area. 10×10 steri-drape across the neck. Mark off the tip of the acromion. The incision is vertically down from the posterior tip to the axillary fold.

Approach

Vertical skin incision. Cautery through the dermis. Mets through the subcutaneous tissue to reach the deltoid fascia. Undermine the subcutaneous tissue so as to expose the fascia (but, like in the rotator cuff repairs, don’t go through it).

Once adequately mobilized, incise the deltoid fascia and split the fibers. The location for where you “go for it” is based on palpating the posterior glenoid. Use mets to split the fibers until you come across the fascia overlying the infraspinatus tendon. Galpis are inserted. Undermine deltoid so that you get a good look at the infraspinatus tendon. He does not attempt to separate infraspinatus from teres minor.

Use cautery to get through the tendon, and use a Howarth to develop the interval between the tendon and the capsule. Start superiorly. The dissection is then carried both horizontally along the superior border of the tendon and vertically through the tendon to expose the capsule. The capsule is THIN and easy to perforate.

Then use a knife to incise the capsule – a horizontal incision, then vertically along the labral edge. Look for a Bankhart equivalent – rare. Then plicate the capsule by reefing up on the inferior limb.

About OrthoNet

FUSE (Find, Use, Share, Expand) Orthopaedic Knowledge

OrthoNet strives to enable orthopaedic residents and medical students on orthopaedic rotations to Find, Use, Share and Expand practical orthopaedic knowledge.

FUSE (for Find, Use, Share, and Expand) was introduced by Yahoo! and is based on their vision for using search to fuse a myriad of services and applications, all of which center on knowledge and its application.

I really like the concept “Find, Use, Share, Expand. The potential from what it implies is huge. Be it search, learning, knowledge, or social networks most of what we do today can be summed up in this simple statement.

OrthoNet consists of hundreds of notes on core topics created during orthopaedic residency. These notes have been sitting on my computer and smart phone for years and I thought it would be useful to make this content available to everyone. I cannot take credit for all the notes, many of them have been inherited over the years from several residents. This basic content however is a small part of what I hope OrthoNet will become. Each resident has a unique training experience based on their exposure to different cases, different surgeons, and different training environments.

OrthoNet provides a unique “blogging” type of interface to allow residents and medical students to append additional information to the topic pages. You could add the surgical approach and rationale recommended by your staff or add a link to another resource which you find useful. We often share our experiences with residents in our own training programs. This sharing process promotes expansion of our own knowledge. Why not increase this sharing across training programs and expand our knowledge collaboratively using the Internet.

The OrthoNet interface is very plain and simple so you can concentrate on Finding, Using, Sharing and Expanding orthopaedic knowledge based on your experiences. The content can be accessed anywhere. The objective is to provide practical information on core topics in orthopaedic surgery at the point of care. This learning on the fly strategy works towards enhancing an educational encounter.

All residents are encourage to become regular contributors to OrthoNet. Simply submit your comments to the daily posts and core topics.

FUSE (Find, Use, Share, Expand) Orthopaedic Knowledge

Christian