Long term outcome and ideal screw placement in Bristow procedure for anterior glenohumeral instability

Introduction: The glenohumeral joint being the most mobile joint is highly susceptible to dislocations. Majority of recurrences occur within 2 years of first traumatic dislocation. Surgical stabilisation is indicated when recurrent instability causes discomfort. Numerous procedures have been described for surgical stabilisation of the shoulder joint. Some of these like the Bankart’s procedure are anatomic and others like the Bristow procedure are non anatomic. We decided to evaluate the long term outcome of the Bristow procedure and the ideal position for screw placement in this procedure. Materials and Method: We evaluated 56 patients who underwent the procedure between 2000 and 2006. They were assessed using the ROWE score which includes stability, range of motion, daily function and pain. Radiographic evaluation was also done to know the status of the graft and confirm screw position. Result: 80% of our patients had good to excellent results at the end of a mean follow up of 10.4 years. The average loss of external rotation was 10 degrees and loss of internal rotation was 5 degrees. The patients with screw at four o’ clock position had a better outcome compared with three o’ clock and five o’ clock positions. Conclusion: The Bristow procedure continues to be an excellent option for recurrent anterior glenohumeral instability. The status of graft union did not correlate functionally. Keywords: Bristow procedure, Glenohumeral instability, Coracoid graft, Screw placement.