[Pale and pulseless hand after luxation of the left elbow in a 9‑year-old boy]

Luxation of the elbow occurs around the age of 7 years instead of a supracondylar humeral fracture. The most common complication is a fracture of the medial epicondyle of the ulna in the sense of a bony avulsion of the ligament. There are only few case reports regarding collateral injuries of the brachial artery. All authors have described this complication as being very rare.

This article reports the case of a 10-year-old boy, who suffered a dorsal luxation of the left elbow. After reduction the left hand was noticeably pale and cold. The diagnostics showed a complete rupture of the brachial artery, associated with a dislocated fracture of the medial epicondyle of the ulna. In addition to the case report, the available literature concerning traumatic rupture of the brachial artery in pediatric elbow dislocation was evaluated.

Because of the results of the clinical examination and the Doppler examination with a lack of blood flow in the brachial artery of the left arm, computed tomography angiography was directly performed. The result was a complete interruption of the brachial artery at the level of the left elbow. The brachial artery rupture was treated using a local vein graft from the brachial vein. The fracture of the medial epicondyle of the ulna was treated by open reduction and an osteosynthesis with Kirschner (k) wires was performed.

The clinical suspicion of an injury of the brachial artery justifies a rapid diagnostic investigation by CT angiography and an open vascular intervention as the only possibility to recreate a sufficient blood flow.