This document outlines the Bristow procedure for treating recurrent anterior shoulder dislocations. It begins with an introduction describing the shoulder's anatomy and instability issues. It then discusses the Bankart lesion pathology and surgical treatment goals. The Bristow operation is described as transferring the short head of the biceps and coracobrachialis muscles to the anterior glenoid rim to add stability. The technique involves exposing the coracoid process and fixing it to the glenoid rim. Post-operative care includes immobilization, progressive range of motion exercises, and return to sports after 3-6 months. The case example is of a 30-year-old female with recurrent right shoulder dislocations to be treated with this procedure.

1. BRISTOW OPERATION
PROCEDURE
Basuki W

2. Introduction
• The shoulder, by virtue of its anatomy &
biomechanics:
– most unstable & frequently dislocation
– 50% of all dislocations
– 95% anterior dislocation
• Failure to immobilize for 3-4 weeks after
reduction of initial treatment  recurrence

3. Anatomy Glenohumeral Joint

4. Anatomy Glenohumeral Joint

5. Pathologic Anatomy
• Bankart 1938:
– 2 types of acute
dislocation:
1. Humeral head is forced
through the capsule, antero-
inferior is the weakest
2. Humeral head is forced
through to anteriorly out of
the glenoid cavity, tears not
only fibrocartilegenous
labrum, but also tears
capsule and periosteum →
Bankart lesion

6. • Hill-Sachs lesion
– Shoulder is dislocated
anteriorly
– Humeral head is
impacted the rim of
glenoid
– Defect on postero
lateral humeral head

7. Surgical treatment
• Anterior instability:
– No single best procedure
• Ideally, the procedure:
1. Low recurrence rate
2. Low complication rate
3. Low re-operation rate
4. No harm (arthritis)
5. Maintain motion
6. Applicable in most cases
7. Allows observation of the joint
8. Corrects the pathologic
9. Not to difficult

8. Bristow operation
• The transferred short head of the
biceps & coracobrachialis muscles
are placed to the anterior glenoid
rim ( Havellius: “must be near not
over anterior glenoid rim)
– Good result :
• Coracoid process < 5 mm medial
to glenoid rim and inferior to
transverse line glenoid
• bony union
• Disadvantages:
– Internal rotation contracture
– Pathologic condition is not
corrected
– Injury to n musculocutaneus
– External rotation is limited
Good result :
• Coracoid process < 5 mm medial to glenoid rim and inferior to transverse line
glenoid
• Bony union

9. Technique Operation
• Deltopectoral incision
• Retract deltoid laterally,
pectoralis major medially
• Expose coracoid process
with its conjoined muscle
attachments
• Cut coracoid process 1-3
cm
• Mobilized coracoid tip
with muscle
• Protect the
musculocutaneus nerve

10. e
• Identify subscapularis
muscle and split in
line with its fibers
from lateral to medial
• Spilt anterior capsule
similar to the
subscapularis muscle
• Fix coracoid tip with
screw

11. • Inspect
musculocutaneus
nerve
• Close longitudinal
split subscapularis
• Reapproximate the
deltopectoral
fascia,subcutaneus
tissue and skin

13. Post Operative
• Immobilized in sling,
• After 2-3 days sling removed, and start
pendulum type exercises
• After 3 weeks start to isometric exercise
• After 6 weeks increasing ROM without
weights
• Noncontact sport are permited after 3
months
• Contact sport after 6 months

14. Case
Female, 30 yo, recurrent anterior
dislocation right shoulder

15. Case
Post Operative