Limb salvage after delayed arterial repair in compound Grade III C fracture humerus: a case report
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20174719Keywords:
Brachial artery injury, Fracture humerus, Doppler study, Collateral circulation, Gangrene, Delayed repairAbstract
A combination of brachial artery injury and fracture shaft of humerus is a rare phenomenon. There is a general apprehension regarding survival of a limb after vascular injury. Only few studies exist in literature that discuss about the survival of such limbs. Our case is a 56 years old female patient who presented three hours after sustaining injury in the form of fracture shaft of humerus and complete transection of brachial artery distal to the origin of profunda brachii. Even though Doppler USG done initially revealed flow in the vessels distal to the injury, a CT Angiogram done later revealed cutting of the brachial artery. This prompted us to perform brachial artery exploration and repair. post operatively, digital subtraction angiography showed absence of flow in the brachial artery but limb survived due to extensive collateral circulation. Even after the golden period of vascular repair has lapsed, arterial repair is recommended if there is no evidence of gangrene. This should be supplemented with adequate systemic anticoagulants and/or fasciotomy.
References
Subasi M, Cakir O, Kesemenli C, Arslan H, Necmioglu S, Eren N. Popliteal artery injuries associated with fractures and dislocations about knee. Acta Orthop Belg. 2001;67:259–66.
Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24:742–6.
Dar AM, Ahanger AG, Wani RA, Bhat MA, Lone GN, Shah SH. Popliteal artery injuries: the Kashmir experience. J Trauma. 2003;55:362–5.
Jagdish K, Paiman M, Nawfar AS, Nawfar MI, Nawfar W, Nawfar WS, et al. The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization. Malaysian Orthop J. 2014;8(1):14–9.
Ekim H, Tuncer M. Management of traumatic brachial artery injuries: a report on 49 patients. Ann Saudi Med. 2009;29:105–9.
Majid M, Kaveh H, Rasouli MR, Mohsen N. Outcome of delayed brachial artery repair in patient with traumatic brachial artery injury:. Prospective study. Int J of Surg. 2008;(6):20–2.
Pezeshki Rad M, Mohammadifard M, Ravari H, Farrokh D, Ansaripour E, Saremi E. Comparing Color Doppler Ultrasonography and Angiography to Assess Traumatic Arterial Injuries of the Extremities. Iranian J Radiol. 2015;12(1):e14258.
Hunt CA, Kingsley JR. Vascular injuries of the upper extremity. South Med J. 2000;93:466–8.
McHenry TP, Holcomb JB, Aoki N, et al. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma. 2002;53:717–21.
Cakir O, Subasi M, Erdem K, Eren N. Treatment of vascular injuries associated with limb fractures. Ann R Coll Surg Engl. 2005;87:348-52.
