2021 Annual Meeting Shoulder Access Pass-Questions and Answers II: Anterior Shoulder Instability: Nuts to Bolts?

Video Transcription

Q&A short to move on to the next session here, but we know that the congruent angle technique allows essentially a larger front porch because you rotate it 90 degrees.  It's also more congruent with your articular surface. But let's say it's a young woman with significant bone loss, let's say it's 30%, she's thin, your coracoid, let's say,  might be 10 millimeters, Dr. Lamplot, or nine millimeters. What about solid screws versus cantilevered screws, minimum size, and what about washers?  Will that bail you out in that situation?  So having seen cannulated screws fail, I personally don't use cannulated screws in that setting. I suppose you can go down to a 3-5 screw  in a smaller coracoid, but I think that graft options like the distal tibia, and we've seen outcomes that are the same after distal tibia as compared to Latter-Jay,  so in an effort to stay out of trouble, I think going to a distal tibia might be a safer option. All right, thank you, and thank you for your paper,  I just want to, Dr. Arciero, you have tremendous experience with certainly open surgery as well on the Latter-Jay in your institution. Any tricks on the size of the screws,  a minimum size, cannulated, not cannulated, washers, what do you do?  So I try to make a preoperative assessment on CT scan of the coracoid. You'd be surprised every once in a while there's a crack in it or a nonunion in it,  and then when I prepare it, I always try to take three centimeters of it, I measure it from the tip of the muscle to the CC ligaments, I try to take it at three,  which means I get about 26 or 27 in length, and then I just take, I always use the traditional, I've not gone to using congruent arc.  I don't like using washers, I used to, but I find that I don't compress as well,  believe it or not, you may prevent cracking, but I think sometimes you leave it a little less compressed, and personally I like to use three, five bicortical screws,  that's what I use, non-cannulated. Okay, great. Thank you, and thank you for the office for this session, it's great papers, I appreciate it. Eric?

Video Summary

During a Q&A session, the speakers discussed various techniques for treating bone loss in a young woman. They mentioned that the congruent angle technique allows for a larger front porch and is more congruent with the articular surface. When it comes to screw options, the use of cannulated screws was discouraged due to their potential for failure. Instead, the speakers recommended considering a distal tibia graft as a safer option. The size of the screws should be assessed preoperatively based on the coracoid's CT scan, with three 5mm bicortical screws being a preferred choice. The use of washers was not favored as it may not compress the area well.

Asset Caption

Michael Pagnani, MD; Stephen Brockmeier, MD; Ian Lo, MD; Joseph Lamplot, MD; Jens Wermers, MSc

Keywords

bone loss

congruent angle technique

screw options

cannulated screws

distal tibia graft