Brachial artery entrapment: compression by the supracondylar process

Osseous variability around the elbow joint

There are many osseous variants that occur around the elbow joint such as supracondylar process, supratrochlear foramen, accessory ossicles, and others. Scientific databases were searched for variants around the elbow joint. Elbow radiographs from our center demonstrating some of these findings were included in the study. The aim of the present review was to provide comprehensive information on the terminology, prevalence, history, etiology, and clinical importance of these variants. These anatomical variants are important for radiologists while interpreting radiographs, computed tomography, and magnetic resonance imaging for trauma and orthopedic surgeons during osteosynthesis at the distal humerus, proximal ulna, and radius.

Lateral Supracondylar Spur Process of the Humerus

The supracondylar process is a rare but commonly reported anatomical variant of the humerus. Though it is usually asymptomatic, it can lead to serious symptoms. In this report, a lateral supracondylar process of the humerus was found. This is much rarer than a medial supracondylar process, and to our knowledge, it has not been reported previously. Surgeons and radiologists must account for supracondylar process variations to diagnose neurovascular pathology in the forearm accurately and quickly to optimize surgical outcomes. Here, we describe the origin and clinical importance of the supracondylar process variant.

Two muscular variations in the elbow associated with the anterior interosseous nerve

The coexistence of different muscular-neurovascular variations is of significant clinical importance. A male cadaver, 76 years old at death, was subjected to routine anatomical dissection; the procedure was performed for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz. The right forearm and hand were dissected using standard techniques according to a strictly specified protocol. The presence accessory head of the flexor pollicis longus may potentially compress the anterior interosseous nerve. The present case report describes a rare variant of the ulnar head of the pronator teres, characterized by two independent bands (i.e., two proximal attachments). The main band originates from the coronoid process and the second originates from the tendon of the biceps brachii. This type of attachment could potentially affect the compression of the ulnar artery running between the two bands. Additionally, the accessory head of the flexor pollicis longus was observed, which started on the medial epicondyle; its coexistence with a high division median nerve creates a potential pressure site on the anterior interesosseous nerve.

Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

BACKGROUND

Severely displaced supracondylar fractures of the humerus in children are frequently associated with complications including neurovascular injuries, non-union, or compartment syndrome. In the current literature, no report exists about postoperative brachial artery entrapment in combination with an inconspicuous preoperative neurovascular examination.

CASE PRESENTATION

We present a case of a 6-year-old white boy with a pulseless radial and ulnar artery after open reduction and internal fixation of a severely displaced supracondylar fracture of his right humerus (Gartland type III) using four K-wires. Remarkably, the preoperative neurovascular examination was inconspicuous. Doppler ultrasound of his brachial artery revealed no pulse when his elbow was in flexion and a faint pulse when it was in full extension 10 hours postoperatively. Revision surgery was performed immediately. On intraoperative examination, a kinking of his brachial artery caused by an entrapment of the tunica externa in the reduced fracture was seen and the artery was released by microsurgical arteriolysis immediately. At the final follow-up examination, positive palpable pulse with good capillary filling and, according to Flynn's criteria, an excellent recovery of elbow function was observed 3 months postoperatively.

CONCLUSIONS

This case demonstrates a rare complication of postoperative artery entrapment with inconspicuous preoperative neurovascular examination. It strongly emphasizes the need for a standardized postoperative neurovascular assessment with fully flexed as well as fully extended elbow.

S, G.V. K, S. L. Morphological study of the supracondylar process of the humerus and its clinical implications

BACKGROUND

The supracondylar process of the humerus, which is also called the supra-epitrochlear, epicondylar, epicondylic process or a supratrochlear spur, is a hook-like, bony spine of variable size that may project distally from the anteromedial surface of the humerus. It represents the embryologic vestigial remnant of climbing animals and seen in many reptiles, most marsupials, cats, lemurs and American monkeys.

MATERIALS AND METHODS

Two hundred and forty dried humeri were studied from department of Anatomy, Sri Siddhartha Medical College, Tumkur, Karnataka, India. The bones were examined for supracondylar process. On finding, the dimensions were recorded and photographed.

RESULTS

Out of 240 dried humeri examined we found only 1 humerus of the left side with an osseous spine on the anteromedial surface. The incidence calculated in this study was 0.41%.

CONCLUSION

The supracondylar process is frequently misjudged as a pathological condition of the bone rather than as a normal anatomical variation. Though, this process has been of more interest to anatomists and anthropologists because of a possible link to the origins and relations of the human races than to clinicians, many of whom are not aware of its occasional presence. It is usually clinically silent, but may become symptomatic by presenting as a mass or can be associated with symptoms of median nerve compression and claudication of the brachial artery.

Forearm arteries entrapment syndrome: a rare cause of recurrent angioaccess thrombosis

Entrapment syndrome below or just above the elbow is uncommon. These rare causes of neurologic or vascular entrapment are linked to anomalous anatomical structures. No case of entrapment syndrome has been reported in patients with angioaccess for hemodialysis. We report, for the first time, forearm arteries entrapment in two patients presenting with recurrent angioaccess for hemodialysis thrombosis. Anatomical, radiologic, and surgical features of these uncommon syndromes are discussed.

Fractures of the supracondylar process of the humerus

The supracondylar process of the humerus is a relatively rare but well-known anatomic variant that can be associated with other anomalies. While it usually remains clinically silent, the spur can be responsible for a wide spectrum of symptoms. We present 3 patients with fractures of the supracondylar process and review 12 other cases in the literature. The supracondylar process has potential for fracture and important neurovascular sequelae.