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

Abstract

This article describes our technique of thoracoscapular fusion with screw fixation for treatment of winging of the scapula in patients with fascioscapulohumeral dystrophy. Perform the Horwitz test. 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. Make an incision along the medial scapular edge, incise the trapezius muscle, and detach the levator scapula, rhomboid major, and rhomboid minor muscles. Do not decorticate the scapula to avoid weakening it. Expose three or four ribs subperiosteally, from their superior border to avoid the neurovascular bundle. Drill the ribs with a McDonald dissector underneath them to prevent damage to the pleura. Pack bone chips or bone-graft substitute between the ribs and the deep surface of the scapula. An adjustable brace with the arm in 60° of abduction and 30° of forward flexion is worn for three months. Between July 1997 and July 2010, a thoracoscapular fusion was performed in thirty-five shoulders of twenty-four patients with fascioscapulohumeral dystrophy¹⁵.IndicationsContraindicationsPitfalls & Challenges.