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DOI: 10.1055/s-0044-1800921
Neurological Anatomy Applied to the Deltopectoral Surgical Approach: Safety Parameters in the Latarjet Procedure
Article in several languages: português | EnglishFinancial Support The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
Abstract
Objective The present study aims to identify neurological safety parameters for performing the Latarjet procedure via the deltopectoral approach in a cross-sectional and prospective analysis of fresh cadavers.
Methods We dissected 12 shoulders from cadavers in good condition with no history of previous surgery or musculoskeletal dysfunction. Their mean age, height, weight, and body mass index (BMI) were the following: 75.33 (41–97) years, 168.81 (149–186) cm, 60.35 (26–77) kg, and 21.38 (11.71–34.22) kg/m2, respectively. We identified the anatomical landmark of the deltopectoral approach (medial glenoid rim, MGR) and measured its distance from the axillary, musculocutaneous, and subscapular nerves.
Results We obtained the following measurements in neutral rotation and 40° external rotation, respectively: distance from the MGR to the axillary nerve (AN), 2.87 cm and 2.58 cm (p = 0.29); distance from the MGR to the musculocutaneous nerve (MCN), 2.70 cm and 2.54 cm (p = 0.36); distance from the MGR to the upper subscapular nerve (USSN), 3.83 cm and 4.00 cm (p = 0.30); distance from the MGR to the middle subscapular nerve (MSSN), 3.50 cm and 3.50 cm (p = 1.00); and distance from the MGR to the lower subscapular nerve (LSSN), 3.00 cm and 2.83 cm (p = 0.36).
Conclusion The deltopectoral approach is safe. However, in the Latarjet procedure, subscapularis muscle splitting and coracoid graft fixation require attention and caution due to the small distance to the adjacent nerves. These precautions can avoid major postoperative complications.
Work carried out at the Shoulder and Elbow Group, Orthopedics and Traumatology Service, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brazil.
Publication History
Received: 29 February 2024
Accepted: 30 August 2024
Article published online:
12 March 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
André Leonardo Nogueira Farias, Leonardo Yabu Tanaka, Larissa Vasconcelos de Castro, Miguel Pereira da Costa, Romulo Brasil Filho, Antonio Carlos Tenor Júnior. Anatomia neurológica aplicada à abordagem cirúrgica deltopeitoral: Parâmetros de segurança no procedimento de Latarjet. Rev Bras Ortop (Sao Paulo) 2025; 60: s00441800921.
DOI: 10.1055/s-0044-1800921
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