Injury to the brachial plexus during Putti-Platt and Bristow procedures

Abstract

Eight patients with documented recurrent anterior dislocation of the shoulder sustained iatrogenic brachial plexus injuries during either Putti-Platt or Bristow procedures. Two patients also sustained axillary artery injuries. There were six males and two females. Postoperatively, complete paralysis of the musculocutaneous nerve was noted in six cases and incomplete paralysis in one case. Two patients had complete axillary nerve palsies. There were two cases of partial paralysis of the radial, median, and ulnar nerves, respectively. Seven of the patients underwent brachial plexus exploration an average of 16 weeks following their initial operation (range, 4 to 40). Suture material was removed from around or within two musculocutaneous nerves and one ulnar, one median, and one axillary nerve. Two lacerated musculocutaneous nerves were amenable to delayed primary repair. Two musculocutaneous, one median and one axillary nerve required grafting. Injury to the brachial plexus was associated with inadequate knowledge of regional anatomy, blind clamping of axillary artery lacerations, use of axillary incisions which limited exposure, and failure to identify the musculocutaneous nerve during Bristow procedures. If a brachial plexus injury occurs during a Putti-Platt or a Bristow procedure and the lesion does not rapidly, progressively, and completely recover, the brachial plexus should be explored since there is a high likelihood of structural neurologic injury.

Complications associated with open coracoid transfer procedures for shoulder instability

“…Study details including patient demographics, follow-up characteristics and details of previous surgery are presented in Table I. These 30 studies described the results of 1658 open coracoid transfer procedures for shoulder instability. Three percent of cases (20 of 636) from 14 studies 1,5,6,9,13,[15][16][17]19,22,24,32,41,45 were revision procedures. Sixteen studies 4,12,29,31,33,36,39,[43][44][45]47,[49][50][51][52][53] (1058 cases) made no comment regarding whether the procedures were primary or revision cases.…”

Musculocutaneous nerve: Histotopographic study and clinical implications

“…Sungpet et al (1998) have suggested that the position of the shoulder dur-ing dissection can affect recorded measurements, since the MCN is anchored to the CB. Many authors have suggested that the point of entry of the MCN into the CB is clinically important (Latarjet, 1954;Helfet, 1958;Richards et al, 1987;Flatow et al, 1989;Resch et al, 1996), and a correlation between more highly positioned points of penetration and frequency of nerve injuries has been reported.…”

Delayed, transient musculocutaneous nerve palsy after the Latarjet procedure

“…2,12,17 In addition, injury due to incorporation of a nerve into the repair construct for open shoulder instability procedures has been reported for the axillary, median, musculocutaneous, and ulnar nerves. 22 Suprascapular nerve injury after the Latarjet procedure has also been described. 19 In this instance, a screw tip interred the spinoglenoid notch, with full recovery of function after removal of the screw.…”

“…19 Other proposed mechanisms of nerve injury after BristowLatarjet procedures have included laceration and traction injuries. 22,24 Although injury to the musculocutaneous nerve during the Bristow-Latarjet procedure is well documented, delayed dysfunction is atypical. Bach et al 3 described a patient who experienced delayed paresthesias after a modified Bristow procedure.…”