A rare combination of an axillary artery and brachial plexus injury due to a proximal humeral fracture

Seagger, Robin M; Kitson, Jeffery

doi:10.4103/0973-6042.59975

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Doppler ultrasound, DSA and venous contrast CTA are useful for to making a definitive diagnosis of axillary artery injuries (3,8,13). Ultrasound requires no wound, is convenient and cheap and is widely used to detect the integrity of the vessels (6).…”

Section: Discussionmentioning

confidence: 99%

“…In case 1, CTA was used to evaluate the result of the injured artery being replaced by a greater saphenous vein segment. Vessel angiography is usually considered to be necessary in performing a diagnosis of the axillary artery injury (3–6,8). …”

Section: Discussionmentioning

confidence: 99%

“…It is usually (3–8,11,13,14) considered to be necessary to repair the artery as soon as possible and even in those with adequate distal perfusion, fracture stabilization and vascular repair is likely to improve the long-term outcome and posttraumatic cold intolerance (15). Conservative management is clearly advised against in an ischemic limb (13).…”

Section: Discussionmentioning

confidence: 99%

“…A short-segment occlusion of the axillary artery between the origins of these arterial branches that prevents the flow through them may be effectively bypassed by these collaterals. A discussion with the vascular surgeons suggested that the vascular injury may be treated conservatively by relying on collateral circulation, as the limb was warm and the brachial plexus injury was not due to a pressure effect from a large hematoma (8). In cases 2 and 3, although the axillary arteries were occluded or ruptured and the patients did not undergo reconstruction, the extremity did not experience ischemia in the long-term due to the rich collateralization.…”

Section: Discussionmentioning

confidence: 99%

“…The injured axillary artery may cause a distal ischemia. Consequently, it is hypothesized that vascular repair by interposition grafting should be the treatment of choice (3–8). For those patients with perfectly viable distal limbs due to an extensive anastomotic network of collateral vessels, it remains uncertain whether the injured axillary artery should be reconstructed.…”

Section: Introductionmentioning

confidence: 99%

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Axillary artery lesions from humeral neck fracture: A study in relation to repair

Zhang

Wang

Tang

et al. 2012

Experimental and Therapeutic Medicine

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Whether axillary artery injuries associated with proximal humeral fractures must be repaired is uncertain. The present study reports three cases treated with various approaches. In case 1, the left humeral surgical neck was broken, the radial pulse disappeared and the arm temperature was significantly reduced. Computerized tomography angiography (CTA) revealed a 3-cm filling deficiency in the axillary artery. The injured artery was reconstructed with a segment of the greater saphenous vein after the fracture was reduced and fixed with a plate. In case 2, the axillary artery was compressed by the broken humeral segment, which caused the right hand to become cool. The fracture was fixed but the axillary artery embolism was not treated. In case 3, the humeral neck was broken with injury to the brachial plexus, although the patient’s hand remained warm. Digital subtraction angiography (DSA) revealed that the axillary artery was injured badly but there was extensive collateral circulation. The proximal humeral fracture was reduced and fixed without artery reconstruction. The three cases all resulted in a good outcome with the bone healed and limb alive. No ischemic necrosis occurred. However, the neurapraxia did not dissappear completely. Axillary artery injury resulting from humeral neck fracture is a rare but disabling traumatic event. Early diagnosis based on signs of acute ischemia of the arm enables early treatment and a favourable outcome. An angiogram is the best way to diagnose the artery injury and evaluate the condition of the collateral circulation. The injured artery in a cold arm should be repaired, while in a warm arm reconstruction is unnecessary due to rich collateral circulation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Axillary artery lesions from humeral neck fracture: A study in relation to repair

Zhang

Wang

Tang

et al. 2012

Experimental and Therapeutic Medicine

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A systematic review of proximal humerus fractures and associated vascular injuries

Shepherd,

Saratzis,

Pepper

et al. 2024

JVS-Vascular Insights

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Axillary Artery Injury Accompanying Humeral Neck Fracture

et al. 2014

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Fractures of the proximal humerus account for approximately 5% of all long bone fractures.1 Arterial injuries resulting from proximal humeral fractures are even less common. The world literature contains 66 instances where proximal humeral fractures cause arterial injuries documented in case reports 1-29 or small series with less than 10 cases. 30-38These are important injuries because delayed diagnosis and treatment may result in serious sequelae including functional impairment, Volkmann ischemic contractures, and even limb loss. We report a case of axillary arterial injury resulting from a proximal humeral fracture and discuss the management of this uncommon disorder. Case ReportA 68-year-old woman fell from a staircase at a height of 8 ft from the ground. She fell onto the left shoulder and immediately experienced severe incapacitating left shoulder pain. She sought attention at a community clinic. The shoulder was tender and swollen and mobility was impaired secondary to pain. Plain radiographs confirmed a fracture of the humeral neck (►Fig. 1). The shoulder was immobilized with a plaster of paris cast and the patient transferred to a tertiary referral hospital for care.She was stabilized in the emergency room and referred to the orthopedic service for a fractured neck of humerus. Although the ipsilateral upper limb was warm and pink, the radial and ulnar pulses were reduced in volume. The junior orthopedic resident removed the cast to examine the limb, but documented no further clinical information in the patient's clinical record. Postimmobilization radiographs were requested.Four hours later, she was evaluated by the senior orthopedic resident who recognized clinical findings suggestive of limb ischemia: cool limb and reduced ipsilateral pulses. The cast was immediately removed and the vascular surgery team urgently summoned.A duplex Doppler scan confirmed the absence of arterial flow at the ipsilateral brachial and radial arteries, but the axillary artery could not be assessed properly due to tenderness and edema at the area. The patient was taken emergently to the operating room for exploration, arterial repair, and joint stabilization.Intraoperatively, a contused segment of the distal axillary artery was encountered, just as it continued to form the brachial artery (►Fig. 2). There were no pulsations within the vessel at this point and no distal flow was detected.The shoulder joint was fixated with a short rod and wires and vessel exploration followed. The contused segment of axillary artery was excised after proximal and distal control. A large intimal flap was found to be obstructing the lumen in the injured segment. A 10-cm segment of proximal great saphenous vein was harvested from the ipsilateral thigh. The reversed vein was used to restore continuity as an AbstractInjuries to the axillary artery from proximal humeral fractures are uncommon. There are only 66 such injuries reported across the world literature to date. We report an additional case of axillary artery injury. This case highlights the...

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A rare combination of an axillary artery and brachial plexus injury due to a proximal humeral fracture

Cited by 6 publications

References 5 publications

Axillary artery lesions from humeral neck fracture: A study in relation to repair

Axillary artery lesions from humeral neck fracture: A study in relation to repair

A systematic review of proximal humerus fractures and associated vascular injuries

Axillary Artery Injury Accompanying Humeral Neck Fracture

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