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Axillary Artery Injury with Intact Radial Pulse following Fracture-Dislocation of Shoulder: A Case Report
1Department of Orthopaedics, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom.
Malaysian Orthopaedic Journal
|January 1, 2020
Summary
Axillary artery injury is rare in elderly patients with proximal humerus fractures after falls. This case highlights diagnosis challenges and successful stenting treatment for posterior circumflex artery avulsion.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Emergency Medicine
Background:
- Axillary artery injury is an uncommon complication of proximal humerus fracture dislocations, especially in elderly patients with low-velocity falls.
- Clinical presentation can be varied, sometimes masking the vascular injury despite intact peripheral pulses.
Observation:
- An 85-year-old female presented with a greater tuberosity fracture and shoulder dislocation.
- Following reduction, she developed brachial plexus palsy with a palpable radial pulse, accompanied by swelling and a drop in hemoglobin.
- CT angiography confirmed an avulsion of the posterior circumflex artery.
Findings:
- The case demonstrates that axillary artery avulsion can occur without overt signs of distal ischemia.
- Brachial plexus involvement can be an early indicator of significant vascular compromise in these injuries.
- Successful endovascular stenting was achieved for the posterior circumflex artery avulsion.
Implications:
- This case underscores the importance of vigilant monitoring for vascular complications in elderly patients with shoulder dislocations and fractures.
- Early diagnosis and intervention, including advanced imaging and endovascular techniques, are crucial for favorable outcomes.
- It highlights the potential for diverse presentations of vascular injury, necessitating a high index of suspicion.
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