Delayed Presentation of a Brachial Artery Pseudoaneurysm After a Supracondylar Humerus Fracture in a 6-year-old Boy: A Case Report

Abstract

Supracondylar fractures of the humerus are the most common elbow fractures in children, accounting for 60% to 70% of all pediatric elbow fractures. These fractures often have neurovascular complications because of deformity and the sharp nature of the fracture fragments. The management of patients who present with diminished or absent pulses, but a well-perfused extremity is a topic of debate. Between 3% and 14% of patients present with an altered vascular examination and a consistent treatment logarithm has not been proposed in the literature. To our knowledge, a brachial artery pseudoaneurysm presenting in a delayed fashion in the setting of a normal vascular examination has not been reported. We report a 6-year-old boy who had a delayed presentation of a brachial artery pseudoaneurysm after a supracondylar humerus fracture, which was repaired with a saphenous vein graft. This is to emphasize close neurological and vascular monitoring even in the setting of a well-perfused hand. In addition, this would suggest that closer postoperative evaluation in significantly displaced fractures should be performed, even beyond the fracture healing stage.

False Aneurysm of the Brachial Artery Secondary to K-Wire Fixation of a Supracondylar Fracture of the Humerus

“…3 Recently a second case has been reported. 5 In that case, the authors did not attribute the vascular injury to the surgical procedure but the high grade of the fracture. Both cases reported had a similar clinical presentation: the persistence of swelling in the antecubital fossa after 4 weeks of the fracture.…”

“…In the present case, the lesion was diagnosed 4 weeks after fracture pinning whereas the previous reported cases were diagnosed 7 months and 5 weeks after the surgery, respectively. 3,5 We report a case of false aneurysm of the humeral artery after fixation with K-wires. The length of the wires was not inadequate.…”

“…4 The false aneurysm is a rarely diagnosed complication of supracondylar fractures of childhood, it has been reported in only two cases. 3,5 The most common cause of false aneurysms of the brachial artery in children is the venipuncture. [6][7][8][9][10][11] Case Report A 7-year-old boy suffered a displaced extension type of supracondylar fracture (Garland II type) of the left humerus after sport accident (►Figs.…”

Arthrogryposis in infancy, multidisciplinary approach: case report

“…In the case described, a subtalar release treatment is planned as the use of plasters, and even release of the soft tissue in the case of arthrogryposis does not provide lasting results [ 11 ]. The literature emphasises the importance of the earliest possible initiation of the corrective action, with the best results obtainable in the first months of life [ 12 ]. While focusing on correcting the joint deformities, the child’s developmental stimulation should not be forgotten.…”

The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children

“…CCDS correctly identified arterial lesions and normal patency of the brachial artery was restored. Along with others, 4,12,14,17,26 we emphasise that in those cases, a satisfactory temporary collateral circulation could not have guaranteed a good long-term outcome. Cold intolerance, sometimes with Raynaud's phenomenon, dysaesthesia, claudication of the forearm, delayed development and growth arrest of the involved limb and complete loss of function have been reported following arterial damage associated with a supracondylar fracture.…”