Brachial Artery Injury Accompanying Closed Elbow Dislocations

Harnarayan, Patrick; Cawich, Shamir O; Harnanan, Dave; Budhooram, Steve

doi:10.1016/j.ijscr.2014.12.009

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…Most of these studies reported on simple elbow dislocation without any associated elbow fracture [6, 9, 13]. The majority of these studies have shown good functional outcome by employing different treatment plans [2, 10, 15]. However, the patient in our study developed elbow dislocation 6 weeks post vascular repair with suboptimal functional outcome.…”

Section: Discussionmentioning

confidence: 75%

“…Some studies have also found that distal ischemia is also related to the degree of damage to the collateral circulation around the elbow joint at the time of injury [9]. The current trend in management of brachial artery injury caused by blunt trauma with evidence of distal ischemia is surgical revascularization using reversed saphenous vein graft [6, 9, 10]. …”

Section: Discussionmentioning

confidence: 99%

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Blunt trauma to the antecubital fossa causing brachial artery injury and minor fractures around the elbow joint, an easily missed diagnosis with potential devastating consequences: a case report

2018

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BackgroundBlunt trauma causing brachial artery injury in a young patient is very rare. Cases of brachial artery injury may be associated with closed elbow dislocation or instability. Elbow dislocation may not be evident clinically and radiologically on initial presentation.Case presentationThis is a case of a 37-year-old, right-hand dominant, Malay man who fell approximately 6 meters from a rambutan tree and his left arm hit the tree trunk on his way down. He was an active tobacco smoker with a 20 pack year smoking history. On clinical examination, Doppler signals over his radial and ulnar arteries were poor. He proceeded with emergency computed tomography angiogram of his left upper limb which showed non-opacification of contrast at the distal left brachial artery just before the bifurcation of the left brachial artery at his left elbow joint. Radiographs and computed tomography scan also showed undisplaced fracture of left lateral epicondyle and radial head with no evidence of elbow dislocation. He subsequently underwent left brachial to brachial artery bypass which was done using reversed saphenous vein graft and recovered well. His fractures were treated using 90 degree long posterior splint for 2 weeks and he was then allowed early range of motion of the left elbow. This patient developed left elbow dislocation 6 weeks postoperatively. Closed manipulative reduction of his left elbow resulted in incomplete reduction. The functional outcome of his left elbow was limited with a range of motion of left elbow of 0–45 degrees. However, he was not keen for surgery to stabilize his elbow joint during his last follow-up 6 months post injury.ConclusionsThis is an uncommon case of brachial artery injury in a civilian caused by blunt trauma associated with occult elbow instability/dislocation and minor fractures around the elbow joint. The treatment of brachial artery injury with clinical evidence of distal ischemia is surgical revascularization. The possibility of elbow instability and dislocation need to be considered in all cases of brachial artery injury because early radiographs and computed tomography scans may be normal. Short-term posterior splint immobilization is not sufficient to prevent recurrent dislocations.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Blunt trauma to the antecubital fossa causing brachial artery injury and minor fractures around the elbow joint, an easily missed diagnosis with potential devastating consequences: a case report

2018

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“…In such cases, the physician should be alerted to excessive swelling at the joint and the presence of median nerve palsy. Surgical treatment with a saphenous vein graft or direct suture should be preferred even in the cases when the neurovascular status is maintained to prevent further claudication and cold intolerance (7,12). However, in our opinion, conservative treatment would be possibly more beneficial for low-demanding patients.…”

Section: Discussionmentioning

confidence: 83%

“…However, we did not perform arteriography during the first visit as our institution preferred Doppler sonography at that moment. Furthermore, as arteriography might be out of reach in smaller hospitals, Doppler sonography is a reasonable alternative (12).…”

Section: Discussionmentioning

confidence: 99%

“…However, it could possibly be explained by brachial and supinator muscles separating the elbow joint from the brachial artery in contrast to the popliteal artery, which lies directly over the joint capsule in the knee (11). Furthermore, only case reports and small series of cases appear in the literature, and there is a lack of consensus on the management of this rare pathology (12,13). We report a case of brachial artery thrombosis after a simple posterolateral dislocation of the elbow joint.…”

Section: Introductionmentioning

confidence: 95%

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Thrombosis of the brachial artery – a rare and devastating complication after a simple closed posterolateral elbow dislocation

Masionis

Bobina

Uvarovas

et al. 2020

AML

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Dislocation of the elbow joint is the second most common dislocation after the shoulder joint. Although this pathology is relatively common, concomitant vascular injuries are rare. We present a case of a patient who sustained a fall on his arm with an outstretched elbow that resulted in a closed simple posterolateral elbow dislocation and delayed thrombosis of the brachial artery followed by two revascularisation surgeries. The physician must always maintain a high index of suspicion for a concomitant vascular injury before and after closed reduction of the elbow joint and have in mind that complete ischemia without any pulsations could be absent because the elbow is surrounded by rich collateral anastomoses. Suspicion should be even stronger in the presence of bony lesions or open injuries. A team of trauma and vascular surgeons has to work hand in hand as surgical treatment with a saphenous graft or direct suture is the first method of choice with the prior requirement of a stable elbow joint.

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Managing Elbow Dislocations

Gottlieb

2022

Annals of Emergency Medicine

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Brachial Artery Injury Accompanying Closed Elbow Dislocations

Cited by 9 publications

References 26 publications

Blunt trauma to the antecubital fossa causing brachial artery injury and minor fractures around the elbow joint, an easily missed diagnosis with potential devastating consequences: a case report

Blunt trauma to the antecubital fossa causing brachial artery injury and minor fractures around the elbow joint, an easily missed diagnosis with potential devastating consequences: a case report

Thrombosis of the brachial artery – a rare and devastating complication after a simple closed posterolateral elbow dislocation

Managing Elbow Dislocations

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