This prospective case series used intraoperative neuromonitoring during 34 open Latarjet procedures. The procedure was divided into 9 stages to identify exactly when the brachial plexus nerves are at greatest risk of iatrogenic injury.
When you assist on a Latarjet, the two stages to have your eyes on the axillary nerve are glenoid exposure and graft insertion. These accounted for 64% of nerve alerts, and the axillary nerve was involved in 78%.
The mechanism is traction, not transection. Alerts clustered when the arm was externally rotated and abducted, which stretches the brachial plexus. The practical move is to return the arm to neutral and pull retractors when signals drop, which recovered most nerves within about 10 minutes.
Time matters. Longer operative time and longer high-risk stages predicted clinical deficit, so move efficiently through exposure and graft fixation and relax the arm during any delay.
Reassure patients that these deficits are almost always transient neurapraxias; all seven in this series resolved within 28 to 165 days. But note the caveat: this is a Level IV series of 34 patients, underpowered to prove neuromonitoring prevents injury.
This prospective case series used intraoperative neuromonitoring during 34 open Latarjet procedures. The procedure was divided into 9 stages to identify exactly when the brachial plexus nerves are at greatest risk of iatrogenic injury.
When you assist on a Latarjet, the two stages to have your eyes on the axillary nerve are glenoid exposure and graft insertion. These accounted for 64% of nerve alerts, and the axillary nerve was involved in 78%.
The mechanism is traction, not transection. Alerts clustered when the arm was externally rotated and abducted, which stretches the brachial plexus. The practical move is to return the arm to neutral and pull retractors when signals drop, which recovered most nerves within about 10 minutes.
Time matters. Longer operative time and longer high-risk stages predicted clinical deficit, so move efficiently through exposure and graft fixation and relax the arm during any delay.
Reassure patients that these deficits are almost always transient neurapraxias; all seven in this series resolved within 28 to 165 days. But note the caveat: this is a Level IV series of 34 patients, underpowered to prove neuromonitoring prevents injury.