Delayed Diagnosis of Rupture of Brachial Artery Due to Closed Posterior Elbow Dislocation

Abstract

Posterior elbow dislocations complicated with brachial artery rupture are rare, especially in the absence of an accompanying fracture. Severe acute ischaemia is not clearly evident in some cases and the diagnosis of arterial damage may not be realised because the collateral circulation around the elbow might mask signs of acute arterial disruption. We report a patient with brachial artery rupture due to closed posterior elbow dislocation. The diagnosis of arterial injury was delayed because the hand was well perfused and radial pulse was present at initial presentation. Our case emphasizes the need for repeated vascular examinations in elbow dislocations, moreover, hospitalisation and observation for at least 24 hours for further possible changes in the vascular status.

Brachial Artery Injury Accompanying Closed Elbow Dislocations

“…As in our case, brachial artery injuries commonly result from a fall on the outstretched hand [19–20] that results in anterior elbow dislocation [21] . They tend to occur in children [4,6,9,12] , although the diagnosis should not be discounted in adults [21–22] .…”

“…They tend to occur in children [4,6,9,12] , although the diagnosis should not be discounted in adults [21–22] . Clinicians should maintain a high index of suspicion for brachial injury when patients present with blunt trauma from a fall onto the elbow coupled with signs suggestive of fracture-dislocation (painful swelling, bruising, loss of contour, and decreased range of motion) and signs of limb ischemia [21] .…”

“…The annual incidence of brachial artery injuries after closed elbow injuries has been reported to range from 0.47% [23] to 0.5% [24] . Additionally, the signs of ischaemia are usually attenuated since there is rich collateral flow in the upper limb through the profunda brachii, ulnar and radial collateral arteries [21] . This explains why Brahmamdam et al [12] described these upper limbs as “pink pulseless hands”.…”

“…This explains why Brahmamdam et al [12] described these upper limbs as “pink pulseless hands”. Instead of frank ischaemia, these patients have subtle signs such as palpable but reduced pulses, decreased capillary refill and reduced pulse oximetry readings [10–12,21,22] . This was similar to a previously reported case by Guler et al [21] where there was normal capillary refill and radial artery pulsation in a patient with total disruption of the brachial artery from a closed elbow dislocation.…”

Analysis of Consecutive Cases of Vascular Injury in Tertiary Level Hospital in Central Nepal

“…Due to the close proximity of vascular structures to the elbow joint, elbow trauma run the risk of vascular injury especially anterior elbow dislocations or penetrating injuries. 15 Our study showed five cases of vascular injury below 15 years mostly associated with elbow trauma and all recovered well mostly by conservative management. Major vessel injury is a serious complication of military and civilian trauma especially road traffic accident.…”