Traumatic occlusion of the brachial artery post trauma

Case contributed by Dr 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
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 haematoma 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 haematoma.  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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Case Information

rID: 41465
Case created: 2nd Dec 2015
Last edited: 3rd Dec 2015
System: Vascular
Inclusion in quiz mode: Included

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