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

A report of eight cases

Divisions of Orthopaedic Surgery and Neurosurgery, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada

A.R. Hudson, MB, ChB, FRCS Ed, FRCS C

Divisions of Orthopaedic Surgery and Neurosurgery, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada

J.T. Bertoia, MD

Divisions of Orthopaedic Surgery and Neurosurgery, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada

J.R. Urbaniak, MD

The Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina

J.P. Waddell, MD, FRCS C

Divisions of Orthopaedic Surgery and Neurosurgery, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada

Eight patients with documented recurrent anterior dis location of the shoulder sustained iatrogenic brachial plexus injuries during either Putti-Platt or Bristow pro cedures. Two patients also sustained axillary artery injuries. There were six males and two females. Post operatively, complete paralysis of the musculocuta neous nerve was noted in six cases and incomplete paralysis in one case. Two patients had complete axil lary nerve palsies. There were two cases of partial paralysis of the radial, median, and ulnar nerves, re spectively.

Seven of the patients underwent brachial plexus ex ploration 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 axil lary artery lacerations, use of axillary incisions which limited exposure, and failure to identify the musculo cutaneous nerve during Bristow procedures. If a brach ial plexus injury occurs during a Putti-Platt or a Bristow procedure and the lesion does not rapidly, progres sively, and completely recover, the brachial plexus should be explored since there is a high likelihood of structural neurologic injury.

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