Neurovascular injury after shoulder hemiarthroplasty: A case report and review of the literature

Abstract

Since shoulder replacement was introduced for the treatment of complex proximal humeral fractures by Neer et al 13 Neer II, C. Brown Jr., T. McLaughlin H. Fracture of the neck of the humerus with dislocation of the head fragment. Am J Surg. 1953; 85: 252-258 Abstract Full Text PDF PubMed Scopus (107) Google Scholar in 1951, its use has grown exponentially. 2 Aval S.M. Durand Jr., P. Shankwiler J.A. Neurovascular injuries to the athlete's shoulder: part I. J Am Acad Orthop Surg. 2007; 15: 249-256 PubMed Google Scholar Neer and Morrison 14 Neer II, C. Morrison D. Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg Am. 1988; 70: 1154-1162 PubMed Google Scholar reported that replacement of the shoulder joint is one of the most technically demanding of the current joint replacement procedures. Despite its clinical success, complications do occur. 15 Norris T. Iannotti J. A prospective outcome study comparing humeral head replacement and total shoulder replacement for primary osteoarthritis of the shoulder. Presented at the 12th Opening Meeting of the American Shoulder and Elbow Surgeons. Ga, AtlantaFebruary 1996 Google Scholar , 16 Passannante A. Spinal anesthesia and permanent neurologic deficit after interscalene block. Anesth Analg. 1996; 82: 873-874 PubMed Google Scholar , 23 Stableforth P. Four-part fractures of the neck of the humerus. J Bone Joint Surg Br. 1984; 66: 104-108 PubMed Google Scholar Although neurologic injury is a rare complication, with an estimated incidence of 1% to 4% in shoulder arthroplasty cases, 6 Cofield R. Complications of shoulder arthroplasty. Instructional Course Lecture No. 317. Presented at the American Academy of Orthopaedic Surgeons Annual Meeting. Calif, San FranciscoFebruary 1993 Google Scholar , 11 Lynch N.M. Cofield R.H. Silbert P.I. Hermann R.C. Neurologic complications after total shoulder arthroplasty. J Shoulder Elbow Surg. 1996; 5: 53-61 Abstract Full Text PDF PubMed Scopus (166) Google Scholar we are unaware of definite data on the prevalence of vascular or combined neurovascular injury. We present a patient who had complete transection of the axillary artery and the distal posterior cord after shoulder hemiarthroplasty.