Wiki Help...Modified Bristow

pinnaclephyserv

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He wrote 29806 but that's not correct...

Modified Bristow: The patient was brought in the operating room and placed supine on a Tenet beach chair with a Spider arm holder. The right upper extremity is prepped and draped in standard fashion for this procedure after placement of an interscalene block by anesthesia in preop hold area. A vertical incision over the deltopectoral interval centered over the coracoid was made. The skin was incised down to the deltopectoral interval. The clavipectoral fascia was cleared and branches of the cephalic vein were coagulated as necessary. A pointed Hohmann was placed over the coracoid. Army-Navy were placed on either side of the incision. These were held by my assistance. The arm was placed in abduction external rotation and the CA ligament was released from the lateral aspect of the coracoid. The arm was then placed in adduction and the pectoralis minor was released from the medial aspect of the coracoid being very careful not to cause embarrassment into the brachial plexus. A point proximal to the tip of the coracoid was identified for placement of the tight rope construct and a sagittal saw was used to make an osteotomy of the coracoid proximal to this point. The adhesions to the coracoid bone block were released with a combination of sharp and blunt dissection. Next, the coracoid bone block was tucked behind the pectorals major tendon. The clavicle pectoral fascia over the subscapularis was removed. The superior border the subscapularis was

identified at the rotator interval in the inferior border was identified at the anterior humeral circumflex vessels. A split of the muscle belly halfway between the superior inferior aspect subscapularis was made with an altered cautery. The axillary nerve was identified and a blunt Hohmann was placed over this to prevent injury to the nerve. I had to have an assistant scrub in just a hole the shoulder in the glenohumeral joint as was very unstable cap dislocating into the field making my exposure difficult. I then open the capsule with a knife in line with the muscle fibers and did a capsulotomy and a partial capsulectomy. I then placed an anterior scapular neck retractor over the anterior glenoid. This gave me excellent exposure to the glenoid which was essentially degloved of all soft tissue from recurrent dislocations. I made a drill hole for the tight rope construct from anterior to posterior through the scapular neck giving myself enough room to have the bone block sit flush with the surface of the glenoid. I then flipped the pectorals major button on the backside of the scapula while inserting it within inserter from Arthrex. I then shuttled the tight rope construct through the coracoid using a Nitinol wire and then placed a button on the front of the tight rope construct walking it down over the coracoid until the coracoid was flush against the anterior scapular neck. I used a knot pusher tightness per a finally. I then through 3 half hitches into this tight rope construct to lock the construct. Once this was done, I cut the sutures. I copiously irrigated the wound. I made sure that hemostasis was achieved.
 
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