Axillary artery injury and brachial plexus palsy as a complication of proximal humerus fractures

Bucci, Gabriella; Lucar-Lopez, Gustavo; Sánchez-González, Jorge Miguel; Malagelada, Francesc; Lopez, J. Palencia; Guevara-Noriega, Kerbi Alejandro

doi:10.1016/j.jor.2017.06.001

Cited by 5 publications

(11 citation statements)

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“…Despite the anatomic proximity of the axillary artery to the clavicle, scapula, and proximal humerus, its injury is rare. There are few reported cases of axillary artery injury following closed trauma in the literature[13]; indeed, we were only able to find a few reports of axillary artery and brachial plexus injury in the English-language literature. In these reports, these injuries mainly resulted from proximal humeral, humeral neck, and rib fractures, shoulder and glenohumeral dislocation, open shoulder injury, and iatrogenic injury.…”

Section: Discussionmentioning

confidence: 99%

“…Axillary artery injuries are also commonly associated with injury to the brachial plexus, with the latter occurring in up to 43% of patients with axillary artery injury[13]. Due to the proximity of the axillary artery and the brachial plexus, the area is predisposed to hemorrhagic lesions, brachial plexus compression, and subsequent ischemia[13]. Vascular occlusion alone can also produce permanent neurological damage; thus, minimizing diagnostic time is vital[13].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the proximity of the axillary artery and the brachial plexus, the area is predisposed to hemorrhagic lesions, brachial plexus compression, and subsequent ischemia[13]. Vascular occlusion alone can also produce permanent neurological damage; thus, minimizing diagnostic time is vital[13]. However, neurological injuries are most frequently caused by the direct infliction of injury on nerve structures by sharp bone fragments[13], with neurological lesions such as these principally affecting patient functional outcomes[13,15].…”

Section: Discussionmentioning

confidence: 99%

“…Emergency surgery is recommended in cases of vascular compromise[16]. The gold standard for treatment includes open reduction and internal fixation of fractures and vascular reconstruction when the lesion is clinically significant or visible by angiography[13]. Ischemia time and the general condition of the patient determine the order and type of definitive treatment that is to be run[13].…”

Section: Discussionmentioning

confidence: 99%

“…The gold standard for treatment includes open reduction and internal fixation of fractures and vascular reconstruction when the lesion is clinically significant or visible by angiography[13]. Ischemia time and the general condition of the patient determine the order and type of definitive treatment that is to be run[13]. In the case of short ischemic time or only mild ischemia of the limb, a quick reduction and definitive fixation of the fracture may be beneficial.…”

Section: Discussionmentioning

confidence: 99%

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Injury to the axillary artery and brachial plexus caused by a closed floating shoulder injury: A case report

Chen¹,

Lian²,

Lin³

et al. 2018

WJCC

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BACKGROUNDA floating shoulder may be associated with catastrophic neurovascular injury and requires a multidisciplinary approach for its management. To maximize the likelihood of good patient outcomes, this unique injury pattern should be recognized in patients as early as possible. This can be difficult to achieve, however, as there are currently few reports of floating shoulder in the literature, meaning that associated neurovascular injuries may be overlooked.CASE SUMMARYWe present here a rare case of floating shoulder with axillary artery injury in a 34-year-old woman. The patient complained of pain and numbness of her left upper limb after losing control of her motorcycle on a highway and falling from the vehicle 2 h ago. No blood pressure reading could be obtained from her left upper limb and no blood oxygen readings could be obtained from any of her left fingers. Computed tomography angiography and duplex ultrasonography revealed interruption of blood flow through the axillary artery, with distal flow being maintained through collateral arteries. The clinical diagnosis including fracture of the left proximal humerus, the left clavicle, and the left scapula, left axillary artery rupture, and left brachial plexus injury. We successfully performed open reduction and internal fixation of the fracture and vascular repair. The patient showed satisfactory recovery that was observed during 4-mo follow-up.CONCLUSIONEmergency surgery can be an effective therapeutic option for the closed floating shoulder with catastrophic axillary artery injury.

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Section: Discussionmentioning

confidence: 99%