Post traumatic occlusion of the brachial artery

Case contributed by Chris O'Donnell

Presentation

Fell off a horse onto left arm. Felt elbow "pop out" with spontaneous reduction. Now swelling and pain. Good perfusion of left hand but reduced radial pulse

Patient Data

Age: 30 years
Gender: Female

10 cm long "occlusion" of the brachial artery as it passes over the distal humeus to its bifurcation into radial and ulnar arteries.  No contrast leak to indicate active bleeding.  Large hematoma in the soft tissues of the lower anterior arm just above the cubital fossa associated with an impaction fracture of the posterior capitellum with impaction along the lateral border of the radial head.  Appearances indicate divergent dislocation of the radius with rotation (and spontaneous reduction).  Degree of disruption to soft tissues associated with this injury is evidenced by the marked hematoma.  CT angiogram repeated in 4 hours showed similar vascular occlusion.

Case Discussion

Arterial injury post elbow dislocation is rare (~ 10%) and usually involves the brachial artery.  In most cases there is transection of the artery but dissection and occlusion is also seen.  Transient reversible arterial "spasm" due to local soft tissue trauma is also possible as well as a compartment syndrome due to soft tissue swelling and bleeding into the arm muscles.

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