This paper describes the Bristow operation for recurrent anterior shoulder dislocation. The coracoid tip with its conjoined tendon is transplanted to the anteroinferior scapular neck. Helfet presents the technique, its rationale, and results from over thirty cases.
The core teaching point is the dynamic sling concept. Unlike a static bone graft, the Bristow transfer tightens the conjoined tendon across the anterior joint as the arm moves into abduction and external rotation, the exact provocative position for anterior instability. Know the two lesions this addresses: the Bankart lesion (labral detachment) and the Hill-Sachs defect (posterior humeral head).
The surgical anatomy is high-yield. The musculocutaneous nerve limits how far the conjoined tendon can be mobilized, and the axillary neurovascular bundle lies medial to the conjoined tendon, so dissection stays lateral.
Helfet's operative observation that the torn labrum adheres to subscapularis rather than to bone explains why primary dislocations recur and supports immobilization in medial rotation. This is the historical basis for modern coracoid transfer (Latarjet), which residents must recognize on exams.
This paper describes the Bristow operation for recurrent anterior shoulder dislocation. The coracoid tip with its conjoined tendon is transplanted to the anteroinferior scapular neck. Helfet presents the technique, its rationale, and results from over thirty cases.
The core teaching point is the dynamic sling concept. Unlike a static bone graft, the Bristow transfer tightens the conjoined tendon across the anterior joint as the arm moves into abduction and external rotation, the exact provocative position for anterior instability. Know the two lesions this addresses: the Bankart lesion (labral detachment) and the Hill-Sachs defect (posterior humeral head).
The surgical anatomy is high-yield. The musculocutaneous nerve limits how far the conjoined tendon can be mobilized, and the axillary neurovascular bundle lies medial to the conjoined tendon, so dissection stays lateral.
Helfet's operative observation that the torn labrum adheres to subscapularis rather than to bone explains why primary dislocations recur and supports immobilization in medial rotation. This is the historical basis for modern coracoid transfer (Latarjet), which residents must recognize on exams.