Avulsive Axillary Artery Injury in Reverse Total Shoulder Arthroplasty
| Autor: | G. Dean Harter, Nathaniel C. Wingert, John D. Beck |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty medicine.medical_treatment Deltoid curve Musculocutaneous nerve Rotator Cuff Injuries Rotator Cuff Axillary artery Peripheral Nerve Injuries Tendon Injuries medicine.artery Humans Medicine Orthopedics and Sports Medicine Arthroplasty Replacement Aged Palsy Shoulder Joint business.industry Rotator cuff injury Vascular System Injuries medicine.disease Arthroplasty Surgery Intraoperative Injury Synostosis Axillary Artery Female business human activities Brachial plexus |
| Zdroj: | Orthopedics. 37 |
| ISSN: | 1938-2367 0147-7447 |
| Popis: | In addition to neurologic injuries such as peripheral nerve palsy, axillary vessel injury should be recognized as a possible complication of reverse total shoulder arthroplasty. Limb lengthening associated with Grammont-type reverse total shoulder arthroplasty places tension across the brachial plexus and axillary vessels and may contribute to observed injuries. The Grammont-type reverse total shoulder arthroplasty prosthesis reverses the shoulder ball and socket, shifts the shoulder center of rotation distal and medial, and lengthens the arm. This alteration of native anatomy converts shearing to compressive glenohumeral joint forces while augmenting and tensioning the deltoid lever arm. Joint stability is enhanced; shoulder elevation is enabled in the rotator cuff–deficient shoulder. Arm lengthening associated with reverse total shoulder arthroplasty places a longitudinal strain on the brachial plexus and axillary vessels. Peripheral nerve palsies and other neurologic complications of reverse total shoulder arthroplasty have been documented. The authors describe a patient with rotator cuff tear arthropathy and a history of radioulnar synostosis who underwent reverse total shoulder arthroplasty complicated by intra-operative injury to the axillary artery and postoperative radial, ulnar, and musculocutaneous nerve palsies. Following a seemingly unremarkable placement of reverse shoulder components, brisk arterial bleeding was encountered while approximating the incised subscapularis tendon in preparation for wound closure. Further exploration revealed an avulsive-type injury of the axillary artery. After an unsuccessful attempt at primary repair, a synthetic arterial bypass graft was placed. Reperfusion of the right upper extremity was achieved and has been maintained to date. Postoperative clinical examination and electromyographic studies confirmed ongoing radial, ulnar, and musculocutaneous neuropathies. |
| Databáze: | OpenAIRE |
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