Fatal Subclavian Artery Transection from Isolated Clavicle Fracture

Kendall, Kevin; Burton, John H.; Cushing, Brad M.

doi:10.1097/00005373-200002000-00022

Cited by 52 publications

(36 citation statements)

References 4 publications

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“…The patients in all the cases developed vascular injury a few days after the onset of trauma and led to the diagnosis of direct aortic puncture by a fractured bone, which was supported by the operative findings. Similarly, from a case of acute onset fatal subclavian artery rupture associated with isolated clavicle fracture due to accidental injury while balding [5].…”

Section: Discussionmentioning

confidence: 99%

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Atypical Traumatic of Pulmonary Artery after Rib Fractures

Hammoumi¹,

Kabiri²

2017

Pulm Crit Care Med

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A 42-year-old patient without notable history, the victim of a highway accident (pedestrian struck by a truck). Admitted to the emergency for severe chest trauma; on admission, the patient was conscious, polypneic, with abdominal breathing, hemodynamically stable. After setting condition, a chest radiograph performed showed left rib fractures with a dissociated fragment from the chest wall, a left fractured scapula and soft parenchymal opacities (Figure 1).The Chest CT objectified multiple storied rib fractures of 2nd to 5th left costal arch with a bone fragment in the endothoracic position threatening pulmonary artery, a moderate left pleural effusion, a basement filling with left lung collapse (Figure 2 and 3). A left thoracic drainage extracted 500cc of blood. The fracture of the scapula was managed by orthopedic treatment. After three days of monitoring in surgical reanimation, the patient respiratory evolution was severe with desaturation to 73%. The arterial gazometry showed a pH to 7.43, a Pa O2 to 34 mmHg and PaCO2 to 39, 4mmhg. wich posed the indication of intubation with assisted ventilation to normalize gasometry results. Furthermore the patient showed signs of pulmonary infection (T°: 38.2, purulent secretions, WBC: 16400 e/mm 3 , CRP: 237 mg/l). Protected distal samples were made and the patient received an antibiotherapy (Amikacin (1g/24h) + Ceftazidime (1 g/6H)) according to the results of the antibiogram with good clinical and biological evolution. The patient had also respiratory physical therapy with daily tracheal aspirations. At the 5th day the patient was extubated and the chest tube removed.

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Section: Discussionmentioning

confidence: 99%

“…Physicians should bear in mind that bone fragments can result in vascular injury and even if most rib fractures can be managed conservatively, we should suggest rib fixation surgery or the resection of the rib edges, especially when the shape of the fractured bone seems at a high risk of vascular injury [2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Atypical Traumatic of Pulmonary Artery after Rib Fractures

Hammoumi¹,

Kabiri²

2017

Pulm Crit Care Med

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“…Subklavian arter, subklavius kası, klavikula, birinci kaburga, derin servikal fasya, kosto-coracoid ligament ve klavikorako-aksiller fasya tarafından korunur. Klavikula kırıkla-rı, travmatik subklavian arter yaralanmalarının %50 nedenini oluşturur (10). Gelişebilecek subklavian arter rüp-türü yaşamı tehlikeye sokacak kanamalara neden olabilir.…”

Section: şEkil 1: İlk Kontraslı Bilgisayarlı Toraks Tomografisi (üç Bunclassified

INTERACTIVE CASE REPORT: Left Subclavian Artery Aneurysm after Gunshot Injury

Çakmak¹,

Durkan²,

Öztürk³

et al. 2016

Respir Case Rep

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“…1 Clavicle fractures are responsible for the 50% of subclavian arterial injuries. 2 The incidence of vascular system damage is 48% in blunt thorax traumas. 3 Vascular injuries can result from upper extremity traumas and in 28% of these the brachial artery is affected.…”

Section: Introductionmentioning

confidence: 99%

Brachial index does not reflect upper extremity functionality following surgery for vascular trauma

et al. 2014

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Objectives: Vascular injuries to the upper extremities requiring surgical repair are common after accidents. However, neither postoperative functionality nor hemodynamic status of the extremity are routinely described. We evaluated the postoperative functional and hemodynamic status of patients with vascular traumas in the upper extremities. Methods: 26 patients who suffered penetrating vascular traumas in the upper extremities from November 2008 to December 2011 were retrospectively evaluated. Data on first approach, surgical technique employed and early postoperative outcomes were recorded. Further data on the post-discharge period, including clinical functional status of the arm, Doppler ultrasonography and brachial-brachial index were also evaluated. Results: Average follow up was 33.5±10.8 months. Right (1.05±0.09) and left (1.04±0.08) brachial indexes were measured during follow up,. Doppler ultrasonography showed arterial occlusion in 4 patients (15%). Near-normal brachial-brachial indexes was observed in all four of these patients with occlusion of one of the upper extremity arteries, even though they exhibited limited arm function for daily work. Conclusions: Evaluation of the postoperative outcomes of this small series of patients with penetrating vascular traumas in the upper extremity revealed that 15% of them suffered occlusion of one artery of the upper extremity. Artery occlusion did not correlate with brachial-brachial Doppler index, probably due to rich collateral circulation, but occlusion was associated with an extremity that was dysfunctional for the purposes of daily work. The result of the brachial-brachial index does not therefore correlate with functionality.Keywords: arterial injury; trauma; upper extremity; brachial-brachial index; multidisciplinary approach. ResumoObjetivos: Os vasos das extremidades superiores são frequentemente lesados em razão de acidentes. Nós pesquisamos a funcionalidade dos membros superiores com base nos resultados cirúrgicos, além do acompanhamento de lesões de outros órgãos e tecidos. Métodos: Entre novembro de 2008 e dezembro de 2011, 26 pacientes foram encaminhados ao nosso serviço de emergência em razão de lesões vasculares traumáticas da extremidade superior, sendo avaliados retrospectivamente. O atendimento inicial aos pacientes, assim como os diagnósticos e as variedades de tratamento, foram avaliados. Após a alta hospitalar, os pacientes foram acompanhados pelo eco-Doppler e pelo índice tornozelobraço. Resultados: O tempo médio de seguimento foi de 33,5±10,8 meses. Durante o seguimento, os índices braquiais direito (1,05±0,09) e esquerdo (1,04±0,08) foram medidos. Na ultrassonografia Doppler, foi observada obstrução arterial em quatro pacientes. Devido à circulação colateral, o índice tornozelo-braço foi próximo do normal nesses pacientes; entretanto, eles apresentavam limitações funcionais dos membros superiores acometidos, para o trabalho diário. Conclusões: Traumas penetrantes são frequentemente observados em adultos jovens. Esses pacientes d...

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Fatal Subclavian Artery Transection from Isolated Clavicle Fracture

Cited by 52 publications

References 4 publications

Atypical Traumatic of Pulmonary Artery after Rib Fractures

Atypical Traumatic of Pulmonary Artery after Rib Fractures

INTERACTIVE CASE REPORT: Left Subclavian Artery Aneurysm after Gunshot Injury

Brachial index does not reflect upper extremity functionality following surgery for vascular trauma

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