Total shoulder arthroplasty (TSA) is a very safe procedure, with an in-hospital mortality rate of just 0.09%.21 The complications of TSA are commonly described as prosthetic loosening, glenohumeral instability, periprosthetic fracture, infection, rotator cuff tear, nerve damage, and deltoid dysfunction.3 Very rarely are more serious complications described in the literature, such as brachial plexus injury22 or axillary artery damage.26 Even outside of TSA, damage to the axillary artery is rare and overwhelmingly described in the literature as a consequence of shoulder dislocation.11 When it is discussed in conjunction with shoulder arthroplasty, most of the literature states that damage to the axillary artery is a risk during reverse shoulder arthroplasty,10,26 with a paucity of information available about the risk during anatomic TSA.8,26 In fact, our literature review could identify only 2 cases that described axillary artery injuries occurring during TSA.26 Similarly, brachial plexus injuries during TSA are very rarely encountered in the literature.22 We present the case of a patient experiencing both iatrogenic axillary artery and brachial plexus injury during elective TSA for glenohumeral arthritis at an outside facility, most likely due to a centralizing glenoid threaded Steinmann pin. Revascularization was attempted more than 24 hours after the onset of ischemia, leading to rhabdomyolysis, multisystem organ failure, and death.
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