Results of modified Bristow procedure.

A modified Bristow procedure was performed on 23 patients over a two-year period. The modification consisted of splitting the subscapularis muscle in line with its fibers and attaching the coracoid process to the neck of the scapula with a malleolar screw. The results were evaluated by questionnaire, physical examination, and radiographs. The average age of the patients was 24 years. There were 20 men and three women. The patients presented 16 left shoulders and seven right shoulders; nine were dominant. The number of previous dislocations was 12. The average follow-up period was 25 months and the average hospital stay was two days. There were no blood transfusions. Each patient returned to his or her preoperative activity level; no patient had pain in the shoulder at rest. With overhead activity, five patients had some pain and 18 had none. Of the nine patients whose surgery was on the dominant side, only two had difficulty in throwing. There were no postoperative recurrent dislocations. There was an average loss of external rotation of 13 degrees and an average loss of internal rotation of 12 degrees. Bony fusion of the coracoid to the neck of the scapula occurred in only one out of 13 shoulders. Complications were minor and resolved completely. The advantages of the procedure are good surgical exposure, minimal tissue trauma, insignificant blood loss, and fewer days in the hospital per patient. The procedure was relatively safe and generally effective.