title: A Comparison of Exposure Between the Classic and Modified Judet Approaches to the Scapula.
abstract: OBJECTIVE
  A debate exists over the optimal approach for addressing fractures of the scapula and glenoid. The purpose of this study is to (1) quantify and compare osseous exposure using modified Judet (MJ) and classic Judet (CJ) approaches and (2) assess the change in scapular exposure after triceps release from the inferior glenoid.
  
  
  METHODS
  Ten arms on 5 fresh-frozen torsos underwent MJ and CJ approaches. A triceps release was performed following the CJ approach in all specimens. Visual and/or palpable access to relevant surgical landmarks was recorded. Calibrated digital photographs were taken of each approach and analyzed using Image J (NIH, Bethesda, MD) to calculate the surface area of exposed bone.
  
  
  RESULTS
  The MJ and CJ approaches exposed 16.8 (±7.58) cm(2) and 98.6 (±25.39) cm(2) of bone, respectively (P < 0.001). The full medial and lateral borders of the scapula were visualized in all approaches with mobilization of the teres minor. Palpable access to the full scapular spine was possible in all cadavers. Although the MJ and CJ approaches only allowed the inferior gleniod neck to be visualized in 1 and 2 specimens, respectively, performing a triceps release provided access to this structure. It also increased the CJ exposure by 12.6 cm(2) (P < 0.001) and allowed palpation of the anterior glenoid margin in 100% of specimens.
  
  
  CONCLUSIONS
  In conclusion, the MJ approach allows similar access to landmarks important for reduction and fixation while exposing only 20% of the surface area typically visualized with the CJ approach.
authors.affiliation: *Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN;†Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC;‡Medical Corps, United States Navy, Naval Medical Center, Portsmouth, VA;§Department of Orthopaedic Clinical Research, Carolinas Medical Center, Charlotte, NC; and‖Shoulder and Elbow Center, OrthoCarolina, Charlotte, NC.
authors.forename: Luke S
authors.initials: LS
authors.lastname: Harmer
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Phelps
authors.forename: Colin V
authors.initials: CV
authors.lastname: Crickard
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Sample
authors.forename: Erica B
authors.initials: EB
authors.lastname: Andrews
authors.forename: Nady
authors.initials: N
authors.lastname: Hamid
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
mesh_terms: D000368:Aged; D059925:Anatomic Landmarks / Q000473:pathology*; D002102:Cadaver; D005260:Female; D050723:Fractures, Bone / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D056888:Patient Positioning / Q000379:methods; D012540:Scapula / Q000293:injuries / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome