Quantitative comparison of exposure for the posterior Judet approach to the scapula with and without deltoid takedown

Background: The purposes of this study are to quantify the extent of the scapula exposed and to describe the osseous landmarks within the dissection of a posterior Judet approach with and without takedown of the posterior deltoid muscle. Methods: The posterior Judet approach using the muscular interval between the teres minor and infraspinatus muscle with and without takedown of the deltoid muscle was performed on 10 fresh-frozen cadaveric shoulders. Retractors with 2kg of force were used at the wound margins for retraction. Upon completion of the exposure, a calibrated digital image was taken from the surgeon's perspective and specific anatomic landmarks were identified. The digital images were then analyzed with a computer software program, ImageJ (National Institutes of Health, Bethesda, MD, USA), to calculate the area (in square centimeters) of bone exposed. Results: The mean area of posterior scapula exposed by the traditional Judet approach with takedown of the deltoid muscle was 30.2cm² (95% confidence interval, 27.7-32.7cm²) compared with 27.3cm² (95% confidence interval, 24.8-29.9cm²) when the deltoid was not detached (P<.0001). In all 10 cadaveric shoulders, the posterior Judet approach without takedown of the deltoid muscle allowed access to the posterior glenoid, lateral scapula border, and spinoglenoid notch. Conclusions: Although takedown of the deltoid muscle improves exposure, the posterior Judet approach without takedown of the posterior deltoid muscle allows for safe exposure to 91% of the bony scapula obtained by removing the deltoid muscle and access to the critical osseous fixation points of the posterior scapula.