Anterior Glenoid Exposure with a Humeral Head Hook Retractor

BACKGROUND

The Fukuda retractor has been designed to retract the humeral head posteriorly and allow exposure of the anterior glenoid during shoulder surgery.¹ We find that the use of this retractor can damage the articular surface of the humeral head and interferes with the operative field. We describe an alternative method that avoids these complications.

TECHNIQUE

The hook retractor has the shape of a large fishing hook without the barb. It is made of stainless steel and measures 38 × 14 cm (Fig 1). The point of the hook is sharp enough to grip cortical bone but blunt enough to avoid its perforation. In its distal end, there is a ring through which sequential weight increments can be added. The retractor is used with the patient supine and the arm flexed around 40° in longitudinal traction. A deltopectoral approach is used. After the tendon of subscapularis is released, the hook is applied to the anterior aspect of the humeral metaphysis outside articular cartilage; by adding weights to the hook, the humeral head is retracted posteriorly.

Figure 1.

The hook retractor.

DISCUSSION

We have used this retractor in more than 400 cases and it has provided an excellent exposure of the anterior glenoid including complex revision cases of instability surgery. The advantages of this retractor include sparing the hand of the assistant, a graduated level of retraction by using different weights, an atraumatic retraction with no articular cartilage damage and no interference with the operative field as the retractor is outside the joint space.