Acute Ischemia of the Upper Limb Fifteen Years after Anterior Dislocation of the Glenohumeral Joint and a Modified Bristow Procedure. A Case Report*

In 1958, Helfet described a stabilization procedure for recurrent anterior dislocations of the shoulder. He named it after his mentor, Bristow, who had taught it to him almost twenty years earlier. The procedure consisted of detaching the tip of the coracoid process from the scapula just distal to the insertion of the pectoralis minor muscle. This piece of coracoid, with the tendons of the short head of the biceps and coracobrachialis attached, was then passed through the subscapularis muscle and placed in contact with a roughened surface of the scapula. It was held in place by suturing the biceps and coracobrachialis tendons to the subscapularis tendon. In 1964, Mead and Sweeney described a modification of the procedure whereby the coracoid is secured to the anterior part of the glenoid rim with a screw. Since then, many modifications have been made concerning the splitting of the subscapularis muscle or tendon; however, all of these modifications have involved the use of a screw to secure the coracoid process to the anterior part of the glenoid rim12. Vascular complications have been rare after the modified Bristow procedure for recurrent anterior dislocations of the glenohumeral joint1,3,4,7,11,15. A review of the literature revealed four previous reports of pseudoaneurysm of the artery after the modified procedure1,3,4,7. We report an unusual case in which ischemia of the distal part of the upper extremity developed secondary to emboli that originated from a pseudoaneurysm of the axillary artery. The pseudoaneurysm was adjacent to a screw that had been inserted fifteen years earlier during a modified Bristow procedure for recurrent anterior dislocations of the shoulder. A fifty-six-year-old man, a general surgeon, was seen in the emergency department of …