BRACHIAL ARTERY TRANSECTION SECONDARY TO OPEN ELBOW

DISLOCATION IN AN 11-YEAR-OLD GIRL

Craig W Milner MD, Rafael D Malgor MD FACS
DEPARTMENT OF SURGERY, UNIVERSITY OF OKLAHOMA-TULSA

INTRODUCTION DISCUSSION
Open elbow dislocation causing brachial artery transection is a Open elbow dislocation associated with injuries to the brachial artery and
rare entity with a few cases reported in the literature.1-3 These median nerve is an uncommon injury, particularly in children. A few
injuries may cause substantial morbidity especially in children. A options for brachial artery repair exist including primary arterial repair
multidisciplinary approach involving both orthopedic and vascular or interposition grafting, which is often an issue in children due to vessel
surgery is critical to achieve the best possible limb function size mismatch.4 A shunting is rarely needed and forearm fasciotomies are
outcome. only indicated in patients with ischemia time > 6 hours or if clinical
suspicion of compartment syndrome is high5. Therefore, quick
assessment and treatment by a multidisciplinary team is key.

CASE PRESENTATION
An 11-year-old girl sustained a left open elbow dislocation after
CONCLUSION
falling from horseback causing a complete transection of her Open elbow dislocations causing brachial artery injury are rare
brachial artery. She was transferred to our regional trauma center challenging cases requiring prompt intervention in order to prevent
after a reported 5-hour history of left forearm and hand ischemia. irreversible neurologic damage or limb loss. Rapid transport to a
Protrusion of her left distal humerus was seen through an open regional trauma center and timely assessment by a multidisciplinary
wound in her antecubital fossa and her left upper extremity was team are essential in order to achieve the best possible limb function
pulseless. The patient was taken to the operating room for washout outcome
and left elbow reduction along with revascularization of left upper
extremity. Due to inadequate conduits for bypass, we elected to
mobilize the brachial artery and to perform an end-to-end REEFERENCES
anastomosis. To decrease tension on the arterial repair, the elbow
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ulnar pulses and her forearm compartments were soft. She was and review of the literature. Orthopedics. 1986;9(4):539-42.
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discharged on postoperative day three on a daily aspirin. At 3- elbow dislocation in a 12-year-old: a case report. Vascular. 2013;21(1):27-30.
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range of motion in the affected upper extremity. ruptured brachial artery following open elbow dislocation. J Hand Surg [Br]. 1994;19(6):788-90.

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