118 Piermatteis Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat

Approach to the Body, Spine, and Acromion Process of the Scapula

Based on a Procedure of Alexander 1
INDICATION
Open reduction of fractures of the scapula.
PATIENT POSITIONING
Place the animal in lateral recumbency with the affected limb uppermost.
DESCRIPTION OF THE PROCEDURE
A. Identify the spine of the scapula, acromion process, and greater tubercle of the humerus
by palpation. The skin and subcutaneous fascial incision is made directly on the spine of
the scapula. The skin and fascia are retracted following the undermining of the edges of
the incision. The length of the incision is adjusted to fit the area of interest in the exposure.
B. An incision is now made in the deep fascia along the spine of the scapula and is
deepened to free the origin of the scapular part of the deltoideus and the insertions of
the omotransversarius and trapezius muscles. These muscles are freed and retracted
sufficiently to expose the spine of the scapula and underlying spinatus muscles.
C. The infraspinatus and supraspinatus muscles are elevated from the spine of the
scapula. The bellies of the muscles can then be bluntly undermined in a distal to
proximal direction using a periosteal elevator (see Figure 19) and then retracted from
the body of the scapula. Near the acromion, an incision can be made a short distance
into the septum between the acromial and scapular parts of the deltoideus to allow
retraction of the scapular part (see Plate 28B, C, D).
ADDITIONAL EXPOSURE
Distal extension to the craniolateral region of the shoulder joint (see Plate 26).
Distal extension to the craniomedial region of the shoulder joint (see Plates 30 and 32).
CLOSURE
A single row of sutures will suffice to close all the incised deep structures. The suture line
runs directly along the spine and includes the deep fascia and the omotransversarius, trapezius, and deltoideus muscles. Subcutaneous tissues and skin are closed in separate layers.
COMMENTS
Elevation of the infraspinatus muscle from the scapular spine is complicated by the presence
of the metacromion in the cat. This caudally projecting protuberance, located on the spine 1
to 2cm proximal to the acromion, overhangs the infraspinatus slightly, but it does not actually alter the procedure.
PRECAUTIONS
Distally the exposure of the neck of the scapula is complicated by the suprascapular nerve
and artery. The suprascapular nerve emerges around the scapular notch, supplying a branch
to the overlying supraspinatus muscle. The nerve then crosses the neck of the scapula distal
to the scapular spine to supply the infraspinatus muscle.

The Scapula and Shoulder Joint 119

PLATE 25

Approach to the Body, Spine, and Acromion Process of the Scapula

Trapezius m.

Incision on spine
of scapula
Omotransversarius m.

Scapular part,
deltoideus m.

Supraspinatus m.

Suprascapular
a. and n.

Infraspinatus m.
Acromion process
Long head, triceps m.
Acromial part,
deltoideus m.