Open Distal Humerus Fracture With Brachial Artery Injury in Adults: A Case Report

Penetrating trauma stands out as the predominant cause of vascular injury in the upper extremity, with the brachial artery being the vessel most frequently affected. While in the pediatric population, a traumatic injury to the brachial artery usually results from a distal humerus fracture; such scenarios are exceptionally reported in the adult population. We report the case of a 21-year-old woman who sustained a comminuted displaced distal humerus fracture associated with a weak radial pulse with no other ischemia signs. Only following open reduction and internal fixation did she present all signs of an acute ischemic limb. An emergency surgery showed a complex brachial artery injury over 3 cm of length. The vascular repair using a venous graft yielded a complete recovery of the patient. While brachial artery injury may be associated with distal humerus fractures in the pediatric population, this complication is exceedingly rare in adults. Our surgical case report serves as a call for clinicians to maintain a heightened awareness and suspicion for brachial artery injury, particularly in cases of severe elbow fractures. The absence of full signs of limb ischemia, owing to a rich collateral blood supply, underscores the importance of careful consideration and proactive management to address this serious complication.