Brachial plexus deficits in patients undergoing shoulder arthroplasty.

Background: Nerve deficit following shoulder arthroplasty can cause significant morbidity. We examined the incidence and pattern of nerve injury following shoulder arthroplasty in a University Hospital. Methods: Retrospective review of all patients undergoing shoulder arthroplasty over a five-year period (September 2014 to August 2019). Patients were identified using clinical codes and relevant data extracted by review of patient records. We excluded patients with preoperative nerve injuries. Results: 220 arthroplasties were performed in 210 patients. The overall nerve deficit rate was 2.3% (5/220). Five nerve deficits occurred following reverse total shoulder arthroplasty (rTSA). In two patients, nerve recovery occurred within 12 months. Two patients had persistent deficits at 12 months. One patient had a deficit at seven months, but incomplete follow up. There was no clear documentation of discussions with clinicians specialising in nerve injury. Conclusion: Nerve injury rates in our series for rTSA are low and comparable to systematic review data. We purport that for rTSA, adequate soft tissue releases, careful arm positioning and retraction alongside limiting over-lowering the centre of rotation may prevent nerve injuries. A postoperative nerve deficit should warrant an opinion from a specialist in nerve surgery with clear referral pathways to allow efficient access to services.

Wrist fusion using an induced membrane technique for forearm salvage in a patient with an infected open injury with segmental bone loss: A case report.

This case report describes the management of a 27-year-old male who, after a quadbike accident, presented with an open, infected, segmental both bone forearm injury with significant bone and soft tissue loss including the radio-carpal joint. Limb salvage was accomplished in the form of a single bone forearm fusion utilising Masquelet's two-stage induced membrane technique to reconstruct the segmental bone defect. The patient proceeded to uneventful bony union by 6 months and returned to driving and riding a quadbike. Despite significant deep infection, successful salvage was achieved using the induced membrane technique. Critical to success was aggressive, repeated debridement alongside restoration of vascular supply and reconstruction of soft tissue defects. We highlight the multidisciplinary approach to management including relevant specialists with a particular interest in limb reconstruction.