Thoracoscapular Fusion for Winging of the Scapula with Screw Fixation for Fascioscapulohumeral Dystrophy (Modified Copeland-Howard Procedure).

INTRODUCTION

This article describes our technique of thoracoscapular fusion with screw fixation for treatment of winging of the scapula in patients with fascioscapulohumeral dystrophy.

STEP 1 PREOPERATIVE EVALUATION: Perform the Horwitz test.

STEP 2 POSITION THE PATIENT AND MARK THE SKIN FOR THE OPERATION: With the patient on a Montreal mattress, position the arms in 90° to 110° of elevation in the scapular plane and approximately 90° of external rotation and mark the skin.

STEP 3 SURGICAL APPROACH: Make an incision along the medial scapular edge, incise the trapezius muscle, and detach the levator scapula, rhomboid major, and rhomboid minor muscles.

STEP 4 PREPARE THE SCAPULA: Do not decorticate the scapula to avoid weakening it.

STEP 5 SELECT AND PREPARE THE RIBS: Expose three or four ribs subperiosteally, from their superior border to avoid the neurovascular bundle.

STEP 6 DRILL THE SCAPULA AND RIBS: Drill the ribs with a McDonald dissector underneath them to prevent damage to the pleura.

STEP 7 HARVEST AND INTRODUCE BONE GRAFT OR USE BONE-GRAFT SUBSTITUTE AND CLOSE: Pack bone chips or bone-graft substitute between the ribs and the deep surface of the scapula.

STEP 8 POSTOPERATIVE IMMOBILIZATION AND REHABILITATION: An adjustable brace with the arm in 60° of abduction and 30° of forward flexion is worn for three months.

RESULTS

Between July 1997 and July 2010, a thoracoscapular fusion was performed in thirty-five shoulders of twenty-four patients with fascioscapulohumeral dystrophy.IndicationsContraindicationsPitfalls & Challenges.