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To Explore or Not? Conservatively Managed Brachial Artery Injury with Good Collateral Flow After Elbow Reduction: A
Leander Paes1, Mohammad Faisal1, Lalit Maini1
1Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.
Introduction:
Elbow dislocation, the second most common dislocation involving a large joint, typically results from a fall on an outstretched hand and most frequently presents as a posterior displacement. Neurovascular compromise may involve the ulnar, median, or radial nerves, with injury to the brachial artery being of particular clinical significance. Due to its anterior location within the cubital fossa and relative fixation, the brachial artery is especially susceptible to stretching or rupture during dislocation. In addition, a well-developed collateral vascular network may preserve distal perfusion and mask underlying ischemia, emphasizing the need for careful neurovascular assessment.
Case Report:
A 55-year-old man presented to the orthopedic emergency department with severe pain, swelling, and immobility of the left elbow. Examination revealed blisters and a posteriorly displaced bony prominence, consistent with a posterior elbow dislocation. The limb appeared pale and dusky, with absent peripheral pulses. Urgent closed reduction was performed under sedation and muscle relaxation, followed by immobilization in a posterior slab. Post-reduction radiographs confirmed an acceptable reduction.
Investigations And Findings:
Following the reduction, radial and ulnar pulses remained absent. Doppler ultrasonography demonstrated thrombosis of the brachial artery, which was confirmed on computed tomography (CT) angiography.
Management And Outcome:
The patient was closely observed for signs of limb ischemia. Within 24 h, distal perfusion improved clinically. In view of the satisfactory perfusion, conservative management was continued with vigilant monitoring, including serial assessment of oxygen saturation, capillary refill time, and early indicators of compartment syndrome.
Conclusion:
This case emphasizes meticulous neurovascular assessment following elbow dislocation reduction. Despite CT angiographic evidence of brachial artery thrombosis, preserved collateral circulation maintained adequate limb perfusion, allowing successful conservative management. Selected patients with stable perfusion and close monitoring may safely avoid surgical intervention.
