|Beitragstitel||Unexpected shocking bleeding in a case of humeral head fracture–dislocation|
Lesions of the axillary artery in case of blunt trauma are rare. They are generally associated with a mechanism of hyper-abduction of the arm. The goal of the abstract is to present a peculiar case with review of the literature.
A 50-years-old woman, known for previous use of recreational drugs and paranoid schizophrenia, comes to the Emergency Department after a ground-level fall with blunt right shoulder trauma. The physical examination of the right shoulder showed soft tissue swelling and tenderness. The skin was pink and warm. Radial and ulnar pulses were palpable. Capillary refilling time < 2 s. No neurological deficit was present. Radiographs showed anterior dislocation and a three part humeral fracture requiring open reduction and osteosynthesis. Through a delto-pectoral approach, an attempt of reduction of the humeral dislocated head was performed. Suddenly, an expected massive shocking bleeding occurred from the axillar region. The bleeding was stopped temporarily by compression until the vascular surgeon revised the area finding aa pre-existing laceration of about 4-5 cm of the axillary artery, . Osteotomy of the coracoid process gave more access for the . thrombectomy and a reversed greater saphenous vein interposition graft from distal subclavian to proximal axillary artery were performed. Fracture is reduced and fixed with a Philos plate, coracoid process is fixed with a cannulated screw.
Interestingly, the few cases described in literature generally showed preoperatively signs of vascular impairment, mainly pulselessness, paleness, pain and paraesthesia.
Therefore, the main message of this case report is that, with a fracture-dislocation of the proximal humerus, although no anamnestic, clinical or imaging sign indicated any vascular impairment, we should always be ready for such complications and if they occur, a vascular surgeon is needed.