Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the arm draped free to allow full access to the shoulder region.

Anatomical surgical approach:  A deltopectoral incision was made, and the interval between the deltoid and pectoralis major muscles was developed. The pseudarthrosis site was exposed, and complete debridement of the pseudo membrane was performed. The fibula was harvested and used to restore the medial column. Proximal tibial autograft and osteogenic/osteoinductive graft substitute were applied. Orthogonal plating was performed to provide stable fixation.

The surgeon noted that due to the synovial pseudarthrosis, the patient had been moving through the pseudoarthrosis rather than the glenohumeral joint, resulting in stiffness. Intraoperative examination under anesthesia revealed surprisingly good motion after gentle manipulation.

Postoperative protocol:   Postoperative rehabilitation included early passive range of motion exercises to prevent stiffness, with gradual progression to active-assisted and active exercises as tolerated. Weight-bearing was restricted until radiological evidence of healing was observed.

Follow up:   Not specified.

Orthopaedic implants used:   Orthogonal plating system, fibular graft, proximal tibial autograft, osteogenic/osteoinductive graft substitute.