The_Invention_of_Surgery

of the shoulder blade. We work together, imaging and imagining; Montreal
and Denver suddenly don’t seem very far away.
Simone cyber-manipulates the scapula, and it’s like having a Gray’s
Anatomy drawing come to life and pirouette in front of me. Instead of a
stout glenoid, with bony integrity to support a regular implant, I am
staring at a pockmarked shoulder socket with a cavernous central defect, a
pothole unable to support the metal baseplate I need to implant. Here,
Simone now transitions to remarkable modernity: we will build an implant
together that will be a computer-aided manufacture (CAM) metal that will
perfectly fit in Stanley’s shoulder. His shoulder is so badly damaged that I
would have never considered doing the case five years ago; today, I can
work with Zimmer Biomet to custom-manufacture a one-of-a-kind implant
that will fit hand-in-glove into the shell of bone, replete with the drill
holes that will facilitate perfectly placed screws into the remaining bone.
This system is a breakthrough that allows me to tackle a shoulder that five
years ago I would have surrendered to. In less than an hour, we have
completely designed the implant, and after signing off on the design,
fabrication on the implant will begin in Warsaw, Indiana.
Weeks have passed since we designed the implant, and the day of
surgery has arrived. Everything else about the case is routine, including
the preoperative interactions, prepping, positioning, surgical approach,
and dissection. But once I get down to the deepest part of his shoulder, the
banality ends. The specialized implant is separately boxed in layers of
sterile packaging, awaiting implantation. Its doppelgänger is a 3-D
printed white polymer stand-in of the exact same dimensions, along with a
3-D printed version of Stanley’s shoulder blade. These life-size,
lightweight, hard plastic models are identical to what I saw on the
computer screen a few weeks ago, and help me to practice where I will
place the real metal implant into Stanley’s ramshackle shoulder socket.
After cleaning the fibrous scar from the cavitary defect, I am peering
deeply into the shoulder socket, an eggshell of bone instead of a
fortification capable of supporting an implant. Formerly, I would have
quaked at such a finding, but we are prepared. Instead of trepidation, I am
filled with pluck, even bravado, because I am armed with a tool that can
transform this case from disaster to triumph. I carefully position the trial
polymer implant in the defect and it perfectly clicks into place. I spend a
few moments examining the fit, and satisfied, insert the actual implant into