Open surgery refers to a traditional, surgical approach to addressing problems with connective tissue in the shoulder. A shoulder orthopaedic surgeon will make an incision of about 5 cm just above the affected area that they need to access under the skin and muscle.
While recovery times are longer for open surgery, the size and scope of the work done during open surgery may be necessary for intensive work, like total shoulder replacement surgery. Opening the shoulder gives surgeons the ability to work with more precision and care.
Open surgery may also be a necessity in order to prevent complications. Certain procedures are more delicate than others, like total shoulder replacement surgery, and the increased working space that open surgery provides increases their chances of successfully treating the patient.Overall, more severe conditions and more intensive procedures may be too difficult for an arthroscopic approach to be suitable.
Laterjet Procedure
A Laterjet procedure is indicated in certain patients with repeated anterior shoulder dislocations. It is also a treatment option in patients with previous failed anterior arthroscopic Bankart procedures. During the procedure the osteotomized coracoid is fixated to the glenoid rim by means of two screws. It is performed through an 6-10cm anterior approach of the shoulder.
Procedure duration: 45 minutes
Post operative rehabilitation: The patient will wear a sling (shoulder immobiliser) for 2 weeks. Thereafter rehabilitation with the assistance of a physiotherapist will commence. No contact sports are allowed for the first 3 months post surgery. Complete and full recovery is expected at 3 to 6 months post surgery.
ORIF Malunion / Nonunion Clavicle
Malunion occurs when the clavicle has united in a shortened or severely angulated position. Nonunion occurs when there is no bony union of the clavicle after 6 months of sustaining the fracture regardless of undergoing surgery or not. Various reasons can lead to these two problems. These include: A malunion / nonunion can lead to chronic pain and abnormal biomechanics of the shoulder girdle.Procedure duration:This is dependent on what is required to address the problem. Theatre time can range anything from 45minutes to 120 minutes. Removal of hardware can be time consuming. Harvesting of autogenous bone graft from the iliac crest in non union cases can add also add additional timePost operative rehabilitation:A sling should be worn for 4-6 weeks to allow bony union. Rehabilitation with a physiotherapist is also indicaed.
Fracture factors such as: comminution or an initial open fracture.
Patient factors such as: smoking, non compliance or immunosuppression.
Technical factors that can play a role include: too short a plate, rigid fixation not obtained or plate/screw failure.
A malunion / nonunion can lead to chronic pain and abnormal biomechanics of the shoulder girdle.
Procedure duration: This is dependent on what is required to address the problem. Theatre time can range anything from 45 minutes to 120 minutes. Removal of hardware can be time consuming. Harvesting of autogenous bone graft from the iliac crest in non union cases can add also add additional time.
Post operative rehabilitation: A sling should be worn for 4-6 weeks to allow bony union. Rehabilitation with a physiotherapist is also indicaed.
AC Joint Reconstruction
An AC Joint reconstruction may be indicated in patient with old AC (acromioclavicular) joint dislocation injuries who experience problem symptoms such as pain and “dead arm”. It is also sometimes indicated in cases where initial surgery was performed and patients still experience problems related to the AC joint. The reconstruction is performed to reconstruct the CC (coracoid-clavicular) ligaments so as to reduce the dislocated clavicle back into its normal anatomic position. Harvested tendons are used to reconstruct these ligaments and are augmented by surgical suture tape.
Procedure duration: This is a demanding procedure as access to the coracoid can be difficult. If a failed implant is already present this has to be removed first and can be time consuming. This procedure can take up to 90-120 minutes.
Post operative rehabilitation: A sling should be worn for 6 weeks to allow healing of the reconstructed ligaments. Physiotherapy will assist in the recovery of full shoulder function after the initial 6 weeks.
Shoulder Arthroplasty (Replacement)
Shoulder arthroplasty or shoulder replacement procedure is indicated in patients suffering from glenohumeral arthritis or rotator cuff arthropathy (also a type of arthritis). During these procedures an artificial (metal) joint is inserted into the shoulder joint to replace the arthritic joint. These a major procedures which a often performed on elderly patients.
Patients should consider a shoulder arthroplasty as a last option in improving range of motion and alleviating pain. A proper and full assessment also needs to be made of the patient preoperatively to assess their fitness for this kind of surgery.
Procedure duration: This is a demanding procedure and theatre time is often 120-180 minutes. The patients remain in hospital for at least 3-4 days post operation.
Post operative rehabilitation: A sling should be worn for between 2-6 weeks depending on the type of arthroplasty performed. Rehabilitation is slow and therefore can continue under the guidance of a physiotherapist for 3-4 months.