1
|
Omar B, Othmane EF, Khalid EJ, Mohammed R, Mohamed R. Thrombosis of the Brachial Artery After Closed Elbow Dislocation. Cureus 2023; 15:e44627. [PMID: 37799259 PMCID: PMC10548161 DOI: 10.7759/cureus.44627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
Posterior dislocation of the elbow joint is the second commonest large joint dislocation that can be experienced due to various traumatic incidents. Although it may be associated with fractures and vascular lesions, in this case report, we describe a patient who encountered a posterolateral elbow dislocation following a fall on their arm with an extended elbow. This dislocation was followed by delayed thrombosis of the brachial artery, necessitating a revascularization surgery. For optimal patient care, physicians should remain vigilant, being cautious about potential vascular injuries both before and after performing a closed reduction of the elbow joint. The suspicion of vascular injury should be even more pronounced when bony lesions or open injuries are present. Effective management of such cases requires a collaborative effort between orthopedic and vascular surgeons. The preferred surgical approach involves the utilization of a saphenous graft, with the essential prerequisite of achieving a stable elbow joint before proceeding with revascularization.
Collapse
Affiliation(s)
- Bensitel Omar
- Orthopedic Surgery P32, Ibn Rochd University Hospital, Casablanca, MAR
| | - El Fahd Othmane
- Orthopedic Surgery P32, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, MAR
| | | | - Rahmi Mohammed
- Orthopedic Surgery P32, Ibn Rochd University Hospital, Casablanca, MAR
| | - Rafai Mohamed
- Orthopedic Surgery P32, Ibn Rochd University Hospital, Casablanca, MAR
| |
Collapse
|
2
|
Goretti C, Pari C, Puzzo A, Rizqallah Y, Bonanno MG, Belluati A. Injury of the brachial artery accompanying simple closed elbow dislocation: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020030. [PMID: 33559638 PMCID: PMC7944710 DOI: 10.23750/abm.v91i14-s.8507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Abstract
Background: Elbow dislocation is the second common dislocation in adults, after the shoulder. The anatomical proximity to the joint of the brachial artery could lead to concomitant vascular injuries, even if their occurrence remains very rare. Method: It is reported the case of a right-hand-dominant 42-year-old man who sustained a simple closed posterior elbow dislocation of his left elbow, associated to a complete brachial artery rupture. He urgently underwent the reduction of the joint dislocation and an artery-repairing surgical procedure using a graft from ipsilateral saphenous vein. Results: The full functional capacity of the elbow was obtained. Conclusions: The abundance of the brachial artery collateral network may hide the presence of a vascular injury, potentially associated to a closed elbow dislocation. Therefore, a high index of suspicious should be maintained. The Emergency Team plays a crucial role in its early diagnosis, which is essential to avoid irreversible ischemia related damages. A prompt reduction of the joint dislocation and the vascular injury surgical repair are required. Regarding the treatment of the concomitant collateral ligaments and capsular injuries, the indication to proceed to the simultaneous ligaments reconstruction is still controversial in literature.
Collapse
|
3
|
Masionis P, Bobina R, Uvarovas V, Porvaneckas N, Šatkauskas I. Thrombosis of the brachial artery - a rare and devastating complication after a simple closed posterolateral elbow dislocation. Acta Med Litu 2019; 26:167-172. [PMID: 32015671 PMCID: PMC6992364 DOI: 10.6001/actamedica.v26i3.4146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/29/2019] [Indexed: 11/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Povilas Masionis
- Centre of Orthopaedics and Traumatology, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, Clinic of Rheumatology, Orthopaedics-Traumatology, and Reconstructive Surgery, Vilnius, Lithuania
| | - Rokas Bobina
- Centre of Orthopaedics and Traumatology, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, Clinic of Rheumatology, Orthopaedics-Traumatology, and Reconstructive Surgery, Vilnius, Lithuania
| | - Valentinas Uvarovas
- Centre of Orthopaedics and Traumatology, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, Clinic of Rheumatology, Orthopaedics-Traumatology, and Reconstructive Surgery, Vilnius, Lithuania
| | - Narūnas Porvaneckas
- Centre of Orthopedics and Traumatology, Republican Vilnius University Hospital, Faculty of Medicine, Vilnius University, Clinic of Rheumatology, Orthopaedics-Traumatology, and Reconstructive Surgery, Vilnius, Lithuania
| | - Igoris Šatkauskas
- Centre of Orthopaedics and Traumatology, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, Clinic of Rheumatology, Orthopaedics-Traumatology, and Reconstructive Surgery, Vilnius, Lithuania
| |
Collapse
|
4
|
Trigo Lahoz L, Lamas Gomez C, Sarasquete Reiriz J, de Caso Rodriguez J, Proubasta Renart I. Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: A new pathological condition of traumatic origin. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
5
|
Trigo Lahoz L, Lamas Gomez C, Sarasquete Reiriz J, de Caso Rodriguez J, Proubasta Renart I. Luxación de codo con fractura ipsilateral del extremo distal del radio asociada a lesión de la arteria braquial. Una nueva entidad patológica de origen traumático. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:146-153. [DOI: 10.1016/j.recot.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/10/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022] Open
|
6
|
C JB, Sampath D, N HR, Motukuru V. Complete Brachial Artery Transection following closed Posterior Elbow Dislocation: A Rare Case Report. J Orthop Case Rep 2015; 5:27-9. [PMID: 27299092 PMCID: PMC4845449 DOI: 10.13107/jocr.2250-0685.338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Vascular injury associated withclosed posterior elbow dislocations is rare and it usually occurs along with open dislocation, anterior dislocation, penetrating injuries, dislocations associated with fracture. We report such a case of closed posterior elbow dislocation with complete brachial artery rupture. CASE REPORT A 58 years old lady sustained posterior dislocation of right elbow following a fall at home. She presented three days later with complaints of severe pain, swelling around the right elbow and numbness of fingers following a closed reduction done elsewhere. Computed graft angiography showed complete transection of brachialartery. Patient was treated with thrombectomy, right great saphenous vein graft interposition repair of brachial artery and forearm fasciotomy. CONCLUSION Vascular injuries associated with posterior elbow dislocation are very rare, but high index of suspicion of arterial injury need to be thought off and repeated vascular examination during pre and post reduction stage should be done to prevent complications.
Collapse
Affiliation(s)
- JayanthKumar B C
- Department of Orthopaedic surgery, St. Martha’s Hospital, Bangalore. India
| | - Deepak Sampath
- Department of Orthopaedic surgery, St. Martha’s Hospital, Bangalore. India
| | - Hanumantha Reddy N
- Department of Orthopaedic surgery, St. Martha’s Hospital, Bangalore. India
| | - Vishnu Motukuru
- Department of Orthopaedic surgery, St. Martha’s Hospital, Bangalore. India
| |
Collapse
|
7
|
Dabboussi NA, Fakih RR, Kassar TA, Abtar HK. Occult closed posterior elbow dislocation with intimal rupture of the brachial artery in a 71-year-old male†. J Surg Case Rep 2014; 2014:rju140. [PMID: 25527603 PMCID: PMC4271272 DOI: 10.1093/jscr/rju140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Posterior elbow dislocation with vascular injury is rarely encountered, but it is crucial for every emergency physician to diagnose it. Missing these injuries can result in neurovascular compromise, which in turn can lead to limb ischemia, compartment syndrome and potential limb loss. Having a normal X-ray on presentation makes this injury more difficult to diagnose. In this study, we present a case of occult posterior elbow dislocation with an intimal injury of the brachial artery. The rarity of these cases, the diagnostic modalities and the treatment options will be reviewed.
Collapse
|
8
|
Thomas LG, Williams DT. Simple posterior elbow dislocation and brachial artery transection. J ROY ARMY MED CORPS 2012; 158:50-2. [PMID: 22545375 DOI: 10.1136/jramc-158-01-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report the uncommon occurrence of a complete brachial artery transection following simple posterior dislocation of the elbow, successfully managed by cephalic vein interposition grafting. This case together with a review of the literature was conducted with the aim of highlighting important issues regarding the diagnosis, management and prognosis of this rare complication.
Collapse
Affiliation(s)
- L G Thomas
- RAMC, Department of Vascular Surgery, Ysbyty Gwynedd, Bangor, UK
| | | |
Collapse
|
9
|
Guler F, Baz AB, Kose O, Cicek EI, Akalin S. Delayed Diagnosis of Rupture of Brachial Artery Due to Closed Posterior Elbow Dislocation. HONG KONG J EMERG ME 2011. [DOI: 10.1177/102490791101800208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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.
Collapse
Affiliation(s)
| | | | | | - EI Cicek
- Golcuk Military Hospital, Orthopaedics and Traumatology Department, Kocaeli, Turkey
| | | |
Collapse
|
10
|
Ayel JE, Bonnevialle N, Lafosse JM, Pidhorz L, Al Homsy M, Mansat P, Chaufour X, Rongieres M, Bonnevialle P. Acute elbow dislocation with arterial rupture. Analysis of nine cases. Orthop Traumatol Surg Res 2009; 95:343-51. [PMID: 19647508 DOI: 10.1016/j.otsr.2009.04.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 03/10/2009] [Accepted: 04/08/2009] [Indexed: 02/02/2023]
Abstract
UNLABELLED Elbow dislocations are the most frequently encountered dislocations after shoulder dislocations. In their vast majority these injuries involve only the joint and carry a good prognosis. Close anatomic proximity to the joint of neurovascular structures put them at risk of concomitant injury but this occurrence remains, actually very rare. The objective of this study is to retrospectively analyze the results of nine cases of elbow dislocations with brachial artery complications and to propose coherent therapeutic guidelines derived from this experience. MATERIALS AND METHODS From 1999 to 2004, 357 elbow dislocations were treated by the traumatology team at the Purpan University Hospital and 340 at the Rangueil University Hospital in Toulouse, France. These two teaching institutions combined their series, contributing to seven dislocations associated with a brachial artery partial rupture, resulting in ischemia. Between 2001 and 2006 at the Le Mans Regional Hospital Center, 138 dislocations of the elbow were treated, and included two cases involving rupture of the brachial artery. In all these institutions' emergency departments, elbow dislocations were mainly treated on an outpatient basis: closed reduction under ultra short-acting products general anesthesia, with stability evaluation followed by cast immobilization. In the rare instances of ischemia, the artery was repaired in concert with the vascular surgery team. All the nine cases had a similar treatment protocol and were submitted to an identical outcome evaluation method. The patients were all males with a mean age of 37.3 years (range, 18-58 years). The combined injury occurred at sports in two cases, because of a fall in three cases and as a result of a traffic accident in four cases. Ischemia was complete in three cases (no radial or ulnar pulse and devascularized hand). In the six other cases, the clinical presentation was subacute. An arteriogram was obtained in five cases after reduction of the dislocation, confirming the brachial axis disruption. Median and/or ulnar nerve injury was suspected in six patients. Only five elbows remained stable after reduction allowing plaster cast immobilization. In the other cases, dislocation recurrence or consequential residual varus/valgus laxity required external fixation or a cross-pinning fixation. An autologous vein, brachial artery bypass was performed in eight cases and an end-to-end anastomosis was carried out in one case. Revascularization was reestablished between 4 and 19 h after injury (mean 10.5 h). RESULTS All the patients were seen at a minimum of 2 years' follow-up (mean of 4.3 years). On the basis of Mayo Clinic score, the results were considered excellent in three cases, good in four cases, and poor in two cases. No patients complained of elbow instability. The X-rays showed a reduced elbow in all cases and heterotopic ossifications in three cases. No degenerative lesion was observed at the longest follow-up. DISCUSSION The incidence of a combined vascular injury with dislocation remains difficult to establish because the literature reports sporadic short series of clinical cases. The prevalence of this association is estimated to be between 0.3 and 1.7% in hospitals. The vascular lesion risk is probably related to the displacement extent and this later as a consequence of the injury intensity. This context calls for a diagnostic warning signal of possibly associated vascular involvement. Assessment of arterial vascularization should be systematic and mandatory with any osteoarticular injury. The slightest vascular status clinical doubt after reducing any dislocation presses for vascular patency work-up: echo-Doppler, angio-scan, arteriography. The multi-parametric nature of these combined injuries explain why their sometimes disappointing outcome remains dependent on the ability to deal with contradictory healing concerns: skin condition, capsular, and ligaments damages, type of revascularization procedure used, joint stability after closed reduction. This last parameter, being a substantial determinant for the period of immobilization, appears crucial to the final functional outcome, particularly in terms of range of motion loss or residual flexion contracture. LEVEL OF EVIDENCE Level IV. Therapeutic retrospective study.
Collapse
Affiliation(s)
- J-E Ayel
- Toulouse Purpan University Hospital Center, Orthopaedics and traumatology Department, bâtiment Putois, 3(e) étage, place Baylac, 31052 Toulouse cedex, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Garrigues GE, Patel MB, Colletti TP, Weaver JP, Mallon WJ. Thrombosis of the brachial artery after closed dislocation of the elbow. ACTA ACUST UNITED AC 2009; 91:1097-9. [DOI: 10.1302/0301-620x.91b8.21882] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The brachial artery is rarely injured after closed dislocation of the elbow. We describe an unusual variation of this injury, namely, a delayed thrombosis of the brachial artery after a closed dislocation sustained during a low-energy fall. This has not previously been described in the English literature, but may be more common than this suggests. We stress the importance of a thorough neurovascular examination and vigilance in regard to this potentially disastrous complication.
Collapse
Affiliation(s)
- G. E. Garrigues
- Duke University Medical Centre, Box 3000, Durham, North Carolina 27710, USA
| | - M. B. Patel
- Duke University Medical Centre, Box 3000, Durham, North Carolina 27710, USA
| | - T. P. Colletti
- Triangle Orthopaedic Associates, 120 William Penn Plaza, Independence Park, Durham, North Carolina 27704, USA
| | - J. P. Weaver
- Regional Vascular Associates, 4301 Ben Franklin Boulevard, Durham, North Carolina 27704, USA
| | - W. J. Mallon
- Triangle Orthopaedic Associates, 120 William Penn Plaza, Independence Park, Durham, North Carolina 27704, USA
| |
Collapse
|
12
|
Martin DJ, Fazzi UG, Leach WJ. Brachial artery transection associated with closed and open dislocation of the elbow. Eur J Emerg Med 2005; 12:30-2. [PMID: 15674082 DOI: 10.1097/00063110-200502000-00008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute dislocations of the elbow complicated by brachial artery involvement are rare but serious injuries. Rapid assessment and a high index of suspicion are essential to facilitate prompt treatment, as delay in diagnosis is associated with a poorer outcome. We present two cases of brachial artery transection after closed and open dislocation of the elbow, and discuss the appropriate management of such patients.
Collapse
Affiliation(s)
- David J Martin
- Department of Orthopaedics, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, Scotland, UK.
| | | | | |
Collapse
|