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Ripoll T, Fairag R, Bonomo I, Gastaud O, Psacharopulo D. Axillary Artery Injuries Associated With Proximal Humerus Fractures: A Literature Review and a Proposal of a Novel Multidisciplinary Surgical Approach. Vasc Endovascular Surg 2024; 58:245-254. [PMID: 37823274 DOI: 10.1177/15385744231206834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Proximal humerus fractures (PHF) are common injuries that can lead to axillary artery injury, which carries the risk of not being identified during initial assessment. The aim of this study was to describe the management of suspected axillary artery injury associated with PHF according to our experience and to describe a new multidisciplinary surgical approach. METHODS This was a single-center retrospective study. A database was created for patients admitted for PHF to the emergency department of the Hospital of Cannes between October 2017 and October 2019. Patients admitted with PHF associated with suspected ipsilateral upper limb ischemia, and/or massive diaphysis displacement, and/or upper limb ipsilateral neurological deficits were included in this study. RESULTS In total, 301 patients diagnosed with PHF were admitted within these periods. Among these patients, 12 presented with suspected axillary artery lesions, of whom, 6 were included in the present study and treated according to our new approach. A description of these 6 cases, along with an extensive literature review is presented. CONCLUSION Based on our experience, the endovascular approach proposed for the management of axillary artery injury associated with proximal humerus fractures is effective, feasible and reproducible.
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Affiliation(s)
- Thomas Ripoll
- Service de Chirurgie Vasculaire, Centre Hospitalier de Cannes, Cannes, France
- Service de Chirurgie Orthopédique, Centre Hospitalier de Cannes, Cannes, France
| | - Rayan Fairag
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Iris Bonomo
- Service de Gynécologie, Institut Bergonié, Bordeaux, France
| | - Olivier Gastaud
- Service de Chirurgie Orthopédique, Centre Hospitalier de Cannes, Cannes, France
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2
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Spagna G, Boehm E, Lorenz C, Moroder P, Scheibel M. [Treatment strategies for traumatic anterior shoulder dislocation]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00113-023-01340-x. [PMID: 37341735 DOI: 10.1007/s00113-023-01340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/22/2023]
Abstract
Anterior glenohumeral instability is the most frequent type of shoulder instability. This is often associated with labral and osseous lesions leading to recurrent instability. A detailed medical history, a physical examination and targeted diagnostic imaging are necessary to assess possible pathological soft tissue alterations as well as bony lesions of the humeral head and the glenoid bone. Early surgical treatment has been shown to reduce the risk of recurrence, especially in young active athletes, and can avoid secondary damage. Shoulder dislocations in older patients also require a detailed assessment and selection of treatment as persisting pain and limitation of movement can occur due to rotator cuff lesions and nerve injuries. The purpose of this article is to provide an overview of the currently available evidence and results regarding diagnostic considerations and conservative vs. surgical treatment and time to return to sport after treatment of a primary anterior shoulder dislocation.
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Affiliation(s)
- Giovanni Spagna
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz.
| | - Elisabeth Boehm
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Christina Lorenz
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Philipp Moroder
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Markus Scheibel
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité-Universitätsmedizin Berlin, Berlin, Deutschland
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3
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Huri G, Aksoy T, Beydemir A, Yigit YA, Yilmaz M. Axillary Artery Transection and Brachial Plexus Injury After Open Inferior Glenohumeral Dislocation: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00019. [PMID: 37094023 DOI: 10.2106/jbjs.cc.22.00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
CASE A judo athlete presented with an open inferior shoulder dislocation that occurred during competition. Examination revealed a transection of the axillary artery and neuropraxia of the posterior cord. Neuropraxia was resolved within 2 weeks. The axillary artery was repaired with a femoral vein graft. He regained full strength, range of motion, and function at 8 months. CONCLUSION Inferior glenohumeral dislocations are rare, and their management can be complicated by vascular and neurological injuries. We emphasize the importance of examination, diagnosis, and treatment of neurovascular pathologies to avoid catastrophic outcomes.
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Affiliation(s)
- Gazi Huri
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Taha Aksoy
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Ataberk Beydemir
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Yigit Aras Yigit
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
| | - Mustafa Yilmaz
- Department of Cardiovascular Surgery, Hacettepe University Hospitals, Ankara, Turkey
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4
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Valdivia Zúñiga CA, Fulvi AN. Fatal Outcome After Reduction of a Superior Shoulder Dislocation, A Case Report and Literature Review: A Case Report and Literature Review. JBJS Case Connect 2021; 11:01709767-202109000-00076. [PMID: 35102041 DOI: 10.2106/jbjs.cc.21.00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE An 81-year-old woman presented a superior glenohumeral dislocation after a low-energy fall, with a mechanism of axial load while the shoulder was in adduction and extension. After successful closed reduction, the patient presented sudden symptoms of severe vascular injury with a protruding axillary hematoma and hypovolemic shock. CONCLUSION Superior shoulder dislocations and vascular injuries are extremely rare among shoulder dislocations, especially after low-energy trauma. Vascular injuries may result in limb compromise and death. We highlight the importance of high clinical suspicion, particularly in superior dislocations, and the importance of prompt management of vascular complications to avoid catastrophic outcomes.
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5
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O'Neill DR, King JJ, Farmer KW. Reverse total shoulder arthroplasty after iatrogenic axillary artery injury: a case report. J Shoulder Elbow Surg 2021; 30:e121-e128. [PMID: 33220415 DOI: 10.1016/j.jse.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Affiliation(s)
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
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6
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Kanda D, Imagama I, Imoto Y, Ohishi M. Bidirectional endovascular treatment for axillary artery injury secondary to proximal humerus fracture: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa526. [PMID: 33604507 PMCID: PMC7876303 DOI: 10.1093/ehjcr/ytaa526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/14/2020] [Accepted: 11/27/2020] [Indexed: 11/14/2022]
Abstract
Background Axillary artery injury secondary to proximal humerus fracture is a rare but serious complication. The management of this injury has traditionally involved surgical treatment. Case summary A 66-year-old female with gait disturbance slipped and fell off her wheelchair at home. She presented to a local hospital with right shoulder pain and was subsequently urgently transferred to our hospital by helicopter because of suspicion of axillary artery injury. Computed tomography angiography revealed disruption of the right axillary artery. We decided to perform endovascular treatment instead of surgical treatment for axillary artery injury. However, since endovascular treatment via the right femoral artery was impossible, we performed bidirectional (right femoral and right brachial artery approaches) endovascular treatment. We expanded the occluded lesion using a 3.5 mm × 40 mm sized balloon and placed a 5.0 mm × 50 mm stent graft (Gore® Viabahn®) across the lesion. The final subclavian injection confirmed that distal flow to the brachial artery was preserved and that there was no leakage of contrast medium from the axillary artery. Discussion We performed endovascular treatment for axillary artery injury secondary to proximal humerus fracture. Although surgical repair is typically performed for this kind of injury, our experience suggests that endovascular treatment might be an option in patients with axillary artery injury.
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Affiliation(s)
- Daisuke Kanda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8520, Japan
| | - Itsumi Imagama
- Department of Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8520, Japan
| | - Yutaka Imoto
- Department of Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8520, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8520, Japan
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Pellicer-Garcia V, Bargay-Juan P. Subclavian-axillary arterial thrombosis and distal embolisation after traumatic anterior glenohumeral dislocation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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8
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Axillary artery intimal dissection with thrombosis and brachial plexus injury after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:e393-e397. [PMID: 31636009 DOI: 10.1016/j.jse.2019.07.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 02/01/2023]
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9
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Subclavian-axillary arterial thrombosis and distal embolisation after traumatic anterior glenohumeral dislocation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:130-133. [PMID: 31753766 DOI: 10.1016/j.recot.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/20/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022] Open
Abstract
Arterial vascular injury associated with anterior dislocation of the shoulder is a rare but potentially devastating complication, often seen in the context of high-energy trauma or penetrating injury. It is a medical emergency that can compromise both the viability and functionality of the limb, as well as the patient's life if it is not identified early and treated properly. However, its diagnosis can be difficult, since it requires a high index of suspicion. The presence of an axillary artery thrombosis after shoulder dislocation resulting from low-energy trauma is extremely rare, even more so with subacute clinical presentation associated with embolism to the radial artery.
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10
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Razaeian S, Rustum S, Sonnow L, Meller R, Krettek C, Hawi N. Axillary Artery Dissection and Thrombosis after Closed Proximal Humerus Fracture - a Rare Interdisciplinary Challenge. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:406-413. [PMID: 31525793 DOI: 10.1055/a-0938-7041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Proximal humerus fractures account for 4 - 6% of all fractures and are a common result of low-energy trauma in the elderly. Concomitant neurovascular injury of the neighboring axillary artery and brachial plexus is a rarity, but has enormous impact on therapy, rehabilitation and prognosis. Diagnosis of axillary artery injury may be delayed due to its varied clinical presentation and lead to prolonged ischemia, distal necrosis and even loss of limb. Thorough clinical examination, high suspicion and identification of known predictors can be helpful in early diagnosis of this rare injury. PATIENTS/MATERIAL AND METHODS We report a case of an intoxicated 76-year-old male who sustained a dislocated proximal humerus fracture, resulting in concomitant brachial plexopathy and axillary artery dissection with secondary thrombosis after a low-energy fall from standing height. Due to mistriage as a neurological emergency the somnolent patient presented under delayed circumstances at our traumatological emergency department, demonstrating pain, paleness, paralysis, paresthesia and non-palpable wrist pulses. Diagnosis was made through high suspicion after clinical examination with the aid of CT angiography. Emergent open reduction and anatomic shoulder hemiarthroplasty was performed followed by axillobrachial interposition grafting using a reversed saphenous vein graft and brachial plexus exploration. RESULTS The surgical treatments were uncomplicated. The affected limb remains viable at 6-week follow-up; however, active shoulder function is limited due to residual brachial plexopathy. CONCLUSION Despite early diagnosis and management of this rare injury, the prognosis for functional recovery is guarded and largely dictated by the extent of neurological injury in the setting of concomitant brachial plexopathy. Brachial plexopathy is highly associated with axillary artery injury and its impact often underestimated in comparison due to its non-limb-threatening nature in the acute setting. Future studies should focus on the long-term prognosis for functional recovery in patients with this rare injury pattern.
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Affiliation(s)
- Sam Razaeian
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - Saad Rustum
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover
| | - Lena Sonnow
- Institut für diagnostische und interventionelle Radiologie, Medizinische Hochschule Hannover
| | - Rupert Meller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | | | - Nael Hawi
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
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11
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Axillary artery laceration after anterior shoulder dislocation reduction. Turk J Emerg Med 2019; 19:87-89. [PMID: 31073545 PMCID: PMC6497926 DOI: 10.1016/j.tjem.2018.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/31/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Glenohumeral dislocation is the most commonly encountered dislocation in the emergency department. The most frequent complications of glenohumeral dislocation are rotator cuff tears and an increase in the risk of recurrent dislocation. Less common acute complications include fractures, neurological complications and vascular injuries. The incidence of axillary artery injury associated with shoulder dislocation is reported to be about 1–2%. Case An 81-year-old male presented to the emergency department with pain in the right shoulder after a fall. On physical examination, the shoulder was in slight abduction and external rotation. Shoulder movements were painful and there was a swelling in the axillary region which was tender to palpation. There was no sensory or motor deficit and the peripheral pulses were equal and palpable. Following the administration of analgesics, shoulder reduction was performed using the flexion-adduction-external rotation method. After reduction, the patient started complaining of axillary pain. On control examination, the patient did not have any motor or sensory deficits, but peripheral pulses were not palpable on the right arm. The right upper extremity computed tomography angiography, which was performed with the suspicion of vascular injury, revealed a right axillary artery rupture. Conclusion Axillary artery injury accompanying anterior shoulder dislocation is a rare but serious condition which may result in limb loss and death.
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12
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Magister S, Bridgforth A, Yarboro S. Axillary Artery Injury Following Closed Reduction of an Age-Indeterminate Anterior Glenohumeral Dislocation. J Orthop Case Rep 2019; 8:53-56. [PMID: 30687664 PMCID: PMC6343555 DOI: 10.13107/jocr.2250-0685.1158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Axillary artery injury is a rare and potentially devastating sequelae of glenohumeral dislocation. While neurovascular exam is critical in all presentations, the presence of “soft” and/or “hard” signs should prompt a more thorough examination and possible employment of advanced imaging techniques. Case Report: We present a case of a 51-year-old male with an axillary artery injury associated with an anterior glenohumeral dislocation. The patient was initially evaluated at an outside hospital where the vascular injury was not immediately identified, and then was subsequently transferred to our institution where he underwent bypass grafting without significant sequela. Additional prophylactic fasciotomies were also performed due to concern for reperfusion compartment syndrome. Conclusion: Although rare, clinicians should actively rule out vascular injuries when evaluating shoulder dislocations, especially in the elderly patient with a known history of atherosclerotic disease, those with evidence of chronic joint instability, and in the setting of high energy injury mechanisms. Hard signs of vascular injury including diminished distal pulses are the hallmark of this complication, and should always prompt vascular surgery consultation.
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Affiliation(s)
- Steven Magister
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - Andrew Bridgforth
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - Seth Yarboro
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
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13
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Gowda SR, Hartley R, Allison R, Aarvold A. Paediatric axillary artery pseudo-aneurysm after simple shoulder dislocation. Shoulder Elbow 2018; 10:270-273. [PMID: 30214493 PMCID: PMC6134532 DOI: 10.1177/1758573217693803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/30/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022]
Abstract
We report the unique case of a 14-year-old male with axillary artery pseudo-aneurysm associated with brachial plexus compression after a simple shoulder dislocation. Following shoulder reduction under anaesthetic, the child was discharged on chemical deep vein thrombosis (DVT) prophylaxis. However, progressive shoulder swelling and upper limb neurological symptoms developed. A multi-disciplinary approach was taken to diagnose and treat this complication. After stopping the anti-coagulants, a combination of endovascular stent-graft and open surgical decompression of the brachial plexus was employed. Paediatric guidelines on DVT prophylaxis are scarce but DVT has never been reported in children following upper limb trauma.
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Affiliation(s)
| | | | | | - Alexander Aarvold
- Poole Hospital NHS Foundation Trust, Poole, UK,Southampton Children’s Hospital, Southampton, UK,Alexander Aarvold, Southampton Children’s Hospital, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.
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14
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Abstract
Because of the lack of bony restraints and minimal articular contact, the glenohumeral joint can attain significant range of motion; however, this results in the propensity for instability. The most generic form of instability, traumatic anterior instability, reliably produces a series of pathoanatomic findings. While reliable, these findings contribute to the complexities of caring for patients after an initial instability event. Numerous studies have examined this issue and determined that careful consideration of patient factors can guide successful treatment, whether it be surgical or nonsurgical, after initial instability. Such forms of treatment have shown to provide a good functional outcome and decreases morbidity. To be able to provide successful treatment requires a thorough understanding of the pathoanatomic of an instability event and the intricacies of the evaluation of a patient after an initial instability event.
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15
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Wang SI. Management of the First-time Traumatic Anterior Shoulder Dislocation. Clin Shoulder Elb 2018; 21:169-175. [PMID: 33330172 PMCID: PMC7726393 DOI: 10.5397/cise.2018.21.3.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.
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Affiliation(s)
- Sung Il Wang
- Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Insitute for Endocrine Sciences and Research Insitute of Clinical Medicine of Chonbuk National University-Biomedical Research Insitute of Chonbuk National University Hospital, Jeonju, Korea
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16
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Hawi N, Ratuszny D, Liodakis E, Omar M, Krettek C, Meller R. [Shoulder dislocations in elderly patients]. Unfallchirurg 2017; 121:126-133. [PMID: 29064032 DOI: 10.1007/s00113-017-0421-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In contrast to shoulder dislocations in younger patients, anterior shoulder dislocation in the elderly is often associated with concomitant injuries to the rotator cuff and fractures. There is also frequent involvement of the brachial plexus or peripheral nerves. After closed reduction and a short period of immobilization, physiotherapy should be performed to restore mobility and strength. The evaluation of the rotator cuff is essential for further treatment decisions. The majority of patients are classically treated conservatively. Elderly patients with accompanying rotator cuff lesions and failed conservative therapy can benefit from a surgical intervention. Reconstructive interventions of the rotator cuff should be principally considered; however, some individuals may benefit from a reverse prosthesis in this elderly subgroup of patients. The challenge for the treating surgeon is to exactly define the structural injury of the shoulder (which may include pre-existing lesions) and to select the optimal treatment option.
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Affiliation(s)
- N Hawi
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - D Ratuszny
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - E Liodakis
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Omar
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Krettek
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - R Meller
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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17
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Palanisamy JV, Vaithilingam A, M A, Das S, Trikha V. Proximal humerus fracture dislocation leading to axillary artery injury in an young adult: Case report of an unusual presentation. J Clin Orthop Trauma 2017; 8:S62-S66. [PMID: 28878544 PMCID: PMC5574851 DOI: 10.1016/j.jcot.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/17/2017] [Accepted: 05/20/2017] [Indexed: 10/19/2022] Open
Abstract
Proximal humerus fractures constitute five percent of all fracture cases. Though rare, severely comminuted proximal humerus fractures can cause injury to neurovascular structure. Majority of these injuries reported in literature were in elderly age group from low velocity injury owing to loss of elasticity of vessel wall. We report a case of proximal humerus fracture dislocation associated with axillary artery injury in a young male due to fall of heavy iron object. Timely exploration and removal of impinging bone fragment restored the blood supply. The purpose of this report is to heighten the clinical suspicion of the vascular injury in patients with proximal humerus fracture dislocations in all age groups.
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18
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Chehata A, Morgan FH, Bonato L. Axillary artery injury after an anterior shoulder fracture dislocation and "periosteal sleeve avulsion of the rotator cuff" (SARC). Case report and review of the literature. Trauma Case Rep 2017; 8:5-10. [PMID: 29644306 PMCID: PMC5883186 DOI: 10.1016/j.tcr.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/05/2022] Open
Abstract
We present the rare complication of an axillary artery injury associated with an anterior dislocation of the humerus and what we believe to be the first reported periosteal sleeve avulsion of the entire rotator cuff (SARC). We review the literature and discuss the cause of this unusual injury pattern.
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Affiliation(s)
- Ash Chehata
- Royal Melbourne Hospital, Melbourne, Australia.,Cabrini Hospital, Malvern, Australia
| | - F Hamish Morgan
- Cabrini Hospital, Malvern, Australia.,Monash University, Melbourne, Australia.,Alfred Health, Alfred Hospital, Melbourne, Australia
| | - Luke Bonato
- Cabrini Hospital, Malvern, Australia.,Monash University, Melbourne, Australia
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19
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Leclerc B, Loisel F, Ferrier M, Al Sayed M, Rinckenbach S, Obert L. Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report. SICOT J 2017; 3:3. [PMID: 28074775 PMCID: PMC5225835 DOI: 10.1051/sicotj/2016041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/19/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes. Methods: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit. Results: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism. Conclusion: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary.
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Affiliation(s)
- Betty Leclerc
- Vascular Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - François Loisel
- Orthopaedic, Traumatology and Hand Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Maxime Ferrier
- Orthopaedic, Traumatology and Hand Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Mazen Al Sayed
- Vascular Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Simon Rinckenbach
- Vascular Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Laurent Obert
- Orthopaedic, Traumatology and Hand Surgery Unit, University Hospital of Besançon, 25030 Besançon, France
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Axillary artery injury from a closed humeral neck fracture: A case report. ACTA ACUST UNITED AC 2016; 41:407-411. [PMID: 27745944 DOI: 10.1016/j.jmv.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/01/2016] [Indexed: 11/22/2022]
Abstract
Axillary artery injury from humeral neck fracture is an uncommon event. Vascular damage due to these injuries may threaten limb loss. In some cases, the signs of ischemia may not be evident just after the injury and may only appear later on. Therefore, a high index of suspicion is essential. It is important to bear this association in mind, so as to make an early diagnosis and avoid serious complications. We are describing the case of a young patient involved in a motor vehicle crash with an axillary artery trauma due to the surgical neck of humerus fracture. The patient underwent a basilic vein grafting, the postoperative course was good.
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Ng AJH, Arora V, Tang HHF, Treseder T, Jain A, Wagner T. Axillary Artery Injury Associated with Proximal Humeral Fractures: Review of Long-Term Vascular, Orthopedic, and Neurologic Outcomes. Ann Vasc Surg 2016; 33:210-9. [DOI: 10.1016/j.avsg.2015.10.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/21/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022]
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Clayton DB, Ratzlaff RA. Axillary artery laceration after an anterior shoulder dislocation presenting as hypovolemic shock. Am J Emerg Med 2016; 34:1739.e1-4. [PMID: 26830390 DOI: 10.1016/j.ajem.2015.12.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 11/26/2022] Open
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Zaraa M, Sehli H, Mahjoub S, Dridi M, Mbarek M. Double level arterial injury with neuropraxia following anterior shoulder dislocation. J Clin Orthop Trauma 2015; 6:277-80. [PMID: 26566344 PMCID: PMC4600840 DOI: 10.1016/j.jcot.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/24/2015] [Indexed: 11/16/2022] Open
Abstract
Vascular and nervous complications are rare after shoulder dislocation. We report the case of a double level arterial injury with neuropraxia following anterior shoulder dislocation that was diagnosed by MultiDetector-row Computed Tomographic (MDCT) angiography and treated by surgical bypass graft and embolectomy. Our case is original, not only because of the rarity of these complications, but also because of the thromboembolism of brachial artery which could be undiagnosed and could compromise prognosis.
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Affiliation(s)
- Mourad Zaraa
- Corresponding author. Tel.: +216 20346501; fax: +216 98346501.
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Fatic N, Radojevic N, Obadovic J, Juskovic A. Axillary Arterial Thrombosis Secondary to Re-Fracture of the Humerus. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the presented case report, we evaluated mechanism of axillary artery thrombosis in cases of repeated fracture of the shoulder. A 73-year-old female fell down on an outstretched hand. Radiographs demonstrated a Neer’s 2-part displaced fracture of the proximal humerus and open fracture of the acromion. Forty years ago, in a car accident, fractures of the same proximal humerus and clavicle occurred and were surgically treated. Two hours after fixation with Kirschner wires, thrombosis of the axillary artery was quickly diagnosed and rapid treatment allowed revascularisation of the arm without any consequences.
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Abstract
Proximal humerus fractures have rarely been associated with injuries to the axillary artery. Most of the fractures described have been Neer 2-part surgical neck fractures with medialization of the shaft fragment and resultant laceration or thrombosis of the axillary artery. No intraoperative deaths have been reported. We present a series of 3 proximal humerus fractures, 2 of which are Neer 3- to 4-part anterior fracture dislocations, and associated axillary artery injury. There were 2 mortalities, 1 intraoperative. After a thorough review of the English literature, we identified an additional 11 cases of axillary artery injury associated with proximal humerus fracture. The purpose of this study was to heighten the clinical suspicion of this vascular injury in patients with proximal humerus fracture dislocations and surgical neck fractures with shaft medialization, as well as to review pathogenesis and guide management decisions.
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Abstract
Glenohumeral instability has a bimodal age distribution, with most affected patients younger than 40 years, but with a second peak in older patients. Glenohumeral dislocations in older patients often present with complex injury patterns, including rotator cuff tears, fractures, and neurovascular injuries. Glenohumeral instability in patients older than 40 years requires a different approach to treatment. An algorithmic approach aids the surgeon in the stepwise decision-making process necessary to treat this injury pattern.
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Affiliation(s)
- E Scott Paxton
- Division of Shoulder and Elbow Surgery, Warren Alpert Medical School of Brown University, 2 Dudley Street, Suite 200, Providence, RI 02905, USA.
| | - Christopher C Dodson
- Department of Orthopedics, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
| | - Mark D Lazarus
- Department of Orthopedics, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
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Iakovlev M, Marchand JB, Poirier P, Bargoin K, Gouëffic Y. Posttraumatic Axillary False Aneurysm after Luxatio Erecta of the Shoulder: Case Report and Literature Review. Ann Vasc Surg 2014; 28:1321.e13-8. [DOI: 10.1016/j.avsg.2014.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/01/2013] [Accepted: 01/03/2014] [Indexed: 11/17/2022]
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28
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López-Hualda A, Marín-Aguado M, Valencia-García H, López-González D, Gavín-González C. Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2013.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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[Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 58:38-43. [PMID: 24131654 DOI: 10.1016/j.recot.2013.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 06/13/2013] [Accepted: 09/05/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. OBJECTIVE To compare injuries and complications after surgery between one group older than forty years of age and another younger group. MATERIAL AND METHODS A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). RESULTS The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group. There was no significant difference between the complications after surgery and the age according to the design (P>.05). CONCLUSIONS Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications.
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Traumatic shoulder injuries: a force mechanism analysis-glenohumeral dislocation and instability. AJR Am J Roentgenol 2013; 201:378-93. [PMID: 23883219 DOI: 10.2214/ajr.12.9986] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Acute traumatic glenohumeral dislocation is one of the most commonly encountered shoulder injuries and can produce a complex combination of associated bony and soft-tissue injuries, the full extent of which is often initially underappreciated. The objectives of this article are to illustrate the relevant anatomy of the shoulder and provide a more intuitive understanding of the complex biomechanics of traumatic glenohumeral instability through the use of 3D modeling and animation to improve the radiologist's awareness of some of the most common injury patterns, and potentially improve the detection of associated injuries. Emphasis is placed on the most critical injuries to determine the ultimate treatment modality, and imaging recommendations are provided. CONCLUSION Understanding the force mechanisms responsible for traumatic glenohumeral dislocation can potentially improve detection of associated secondary injuries, which can guide more effective injury classification and ultimately direct more appropriate and timely intervention.
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Nour M, Zerhouni H, Bensaid B, Khaloufi S, Ouazzani L, Aqquaoui L, Elhami I, Oubejja H, Erraji M, Ettayebi F. [Axillary artery pseudo-aneurysm secondary to shoulder dislocation in children]. ACTA ACUST UNITED AC 2013; 38:377-80. [PMID: 24042011 DOI: 10.1016/j.jmv.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
Axillary artery injury following anterior dislocation of the shoulder in children is a rare complication often considered as iatrogenic. We report the case of a pseudo-aneurysm of the axillary artery in a 5-year-old boy that appeared four months after a shoulder dislocation that was reduced in an ambulatory setting. Although this is an uncommon vascular complication, we emphasize the need for short-term and long-term follow-up in these children to avoid missing a pseudo-aneurysm of the axillary artery.
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Affiliation(s)
- M Nour
- Service des urgences chirurgicales pédiatriques, hôpital d'Enfant-Rabat, Rabat, Maroc.
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Ergüneş K, Yazman S, Yetkin U, Cakır V, Gurbuz A. Axillary artery transection after shoulder dislocation. Ann Vasc Surg 2013; 27:974.e7-10. [PMID: 23849653 DOI: 10.1016/j.avsg.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 03/30/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
Axillary artery transection after shoulder dislocation without bone fracture is extremely rare. Early diagnosis, use of the occlusion balloon for proximal control of axillary artery bleeding, and surgical treatment are important to avoid morbidity and mortality. A 74-year old man presented with a complete transection of axillary artery associated with anterior dislocation of the shoulder without bone fracture. Left axillary artery transection was seen on angiography. An angioplasty balloon was used to prevent bleeding from the subclavian artery. The brachial plexus was compressed by a hematoma. Axillary artery repair was performed with an autologous reversed saphenous vein graft interposition. The patient had palpable distal pulses postoperatively. Motor function was significantly improved but still impaired in the postoperative period. Follow-up at 3 months showed good function of the left arm.Successful management of axillary artery injuries requires prompt diagnosis and surgical treatment. Neurologic injury may affect the functional outcome of the limb.
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Affiliation(s)
- Kazim Ergüneş
- Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital, Izmir, Turkey.
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33
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Ortigosa Mateo A, Zanabili A, Adeba E, Vega F, Camblor L, Gutiérrez Julián J. Reparación endovascular de rotura de arteria axilar tras luxación anterior de hombro. Caso clínico y revisión bibliográfica. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2013.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Delayed Axillary Artery Pseudoaneurysm as an Isolated Consequence to Anterior Dislocation of the Shoulder. Ann Vasc Surg 2012; 26:279.e9-12. [DOI: 10.1016/j.avsg.2011.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/22/2011] [Accepted: 05/15/2011] [Indexed: 11/22/2022]
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Bois AJ, Dzus AK. Neurovascular Injury Following Traumatic Posterior Shoulder Dislocation in an Adolescent Contact Athlete: A Case Report. JBJS Case Connect 2011; 1:e1. [PMID: 29252251 DOI: 10.2106/jbjs.cc.k.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Aaron J Bois
- Division of Orthopaedic Surgery, Department of Surgery, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N OW8, Canada. .
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Plaga BR, Looby P, Feldhaus SJ, Kreutzmann K, Babb A. Axillary Artery Injury Secondary to Inferior Shoulder Dislocation. J Emerg Med 2010; 39:599-601. [DOI: 10.1016/j.jemermed.2008.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 01/20/2008] [Accepted: 01/29/2008] [Indexed: 11/30/2022]
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Karkos CD, Karamanos DG, Papazoglou KO, Papadimitriou DN, Zambas N, Gerogiannis IN, Gerassimidis TS. Axillary artery transection after recurrent anterior shoulder dislocation. Am J Emerg Med 2010; 28:119.e5-7. [PMID: 20006234 DOI: 10.1016/j.ajem.2009.04.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 04/22/2009] [Indexed: 10/20/2022] Open
Abstract
Axillary artery transection after recurrent anterior shoulder dislocation is extremely rare. We present 2 such patients. The first, a 62-year-old man, presented with acute ischemia and a large hematoma in the axilla and chest wall. The second, a 63-year-old man, had a pseudoaneurysm and palpable peripheral pulses. Both underwent urgent computed tomography, which confirmed the clinical diagnosis, and the patients were taken to the operating room. In the first patient, intraoperative angiogram through both the brachial and the femoral route showed complete disruption of the axillary artery rendering an endovascular approach not possible. Proximal balloon occlusion was then undertaken through the femoral artery, controlling the bleeding and allowing easier dissection of the ruptured segment. Revascularization was performed with an interposition polytetrafluoroethylene (PTFE) bypass restoring normal blood supply to the upper extremity. The second patient had a Viabhan (W.L. Gore, Flagstaff, Ariz) stent-graft implanted through the brachial artery with an excellent clinical and angiographic result. As expected, both patients had significant neurologic morbidity due to associated brachial plexus palsy. Ruptured axillary artery after shoulder dislocation is very uncommon. Endovascular repair and hybrid procedures combining open and endovascular techniques can offer reliable solutions to these challenging problems.
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Affiliation(s)
- Christos D Karkos
- 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, 546 42 Thessaloniki, Greece.
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Reid D, Chue WL. Endovascular management of an axillary arterial injury post shoulder dislocation. Emerg Med Australas 2009; 21:515-7. [PMID: 20002724 DOI: 10.1111/j.1742-6723.2009.01235.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Axillary arterial injury is a rare complication of non-recurrent glenohumeral joint dislocation. Previously this type of injury would have required open exploration of the axillary artery with associated risk of iatrogenic injury to the axillary vein or brachial plexus. We present the case of a 75-year-old lady, who following a fall in her own home, sustained a dislocation of her right shoulder joint complicated by avulsion of a branch of her axillary artery. We describe the successful endovascular management of the injury using a self-expanding stent and propose this as the preferred surgical option where the artery is not completely transected.
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Affiliation(s)
- David Reid
- Department of Surgery, Frankston Hospital, Frankston, Vic. 3199, Australia.
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Abstract
INTRODUCTION Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management. MATERIALS AND METHODS We have discussed this condition with our colleagues and performed a Medline search ('anterior shoulder dislocation') of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint. RESULTS Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition. CONCLUSIONS Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae.
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Affiliation(s)
- Steven Cutts
- Department of Orthopaedics and Trauma Surgery, University Hospitals of Coventry and Warwickshire, UK.
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40
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Mathieu L, Chetboun A, Nourissat G, Doursounian L. [Rupture of axillary artery and brachial plexus paralysis as complications of recurrent anterior glenohumeral dislocation: a case report]. CHIRURGIE DE LA MAIN 2009; 28:103-6. [PMID: 19261504 DOI: 10.1016/j.main.2009.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 12/23/2008] [Accepted: 01/18/2009] [Indexed: 11/25/2022]
Abstract
The authors report a case of transection of the axillary artery and brachial plexus paralysis following recurrent anterior glenohumeral dislocation. Subsequent vascular reconstruction was performed using a venous interposition graft. The brachial plexus was explored at the same time and found to be in continuity. Neurological recovery was complete within a few months.
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Affiliation(s)
- L Mathieu
- Service de chirurgie orthopédique et traumatologie, hôpital Saint-Antoine, 75012 Paris, France.
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41
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Endovascular Treatment of an Axillary Pseudoaneurysm Following a Traumatic Shoulder Dislocation. Eur J Trauma Emerg Surg 2008; 35:417. [PMID: 26815061 DOI: 10.1007/s00068-008-8117-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
Abstract
A pseudoaneurysm following a shoulder dislocation is considered rare. We report here a case of an 82-yearold man who suffered from vascular and neurological injury due to an axillary pseudoaneurysm following anterior dislocation of the left shoulder. An emerging swelling in the shoulder region was caused by a hematoma and a slowly bleeding pseudoaneurysm in combination with reactive swelling of the soft tissues. Neurological damage occurred due to local compression. A minimally invasive technique was used to treat the pseudoaneurysm. Embolization was initially attempted, but this treatment failed. A stent was subsequently inserted to eliminate the axillary pseudoaneurysm from the circulation. Early imaging and an aggressive endovascular treatment should be considered in all patients suffering from an axillary artery (pseudo)aneurysm.
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Inui A, Kokubu T, Fujioka H, Toyokawa N, Nakagiri K, Doita M, Kurosaka M. Shoulder fracture dislocation associated with axillary artery injury: a case report. J Shoulder Elbow Surg 2008; 18:e14-6. [PMID: 19062312 DOI: 10.1016/j.jse.2008.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/04/2008] [Accepted: 07/07/2008] [Indexed: 02/01/2023]
Affiliation(s)
- Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Bravman JT, Ipaktchi K, Biffl WL, Stahel PF. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries. Scand J Trauma Resusc Emerg Med 2008; 16:16. [PMID: 19032757 PMCID: PMC2637899 DOI: 10.1186/1757-7241-16-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 11/25/2008] [Indexed: 11/26/2022] Open
Abstract
Background Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries. Methods Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples. Results A major diagnostic pitfall is represented by the insidious presentation of significant upper extremity arterial injuries with intact pulses and normal capillary refill distal to the injury site, due to collateral perfusion. Thus, severe vascular injuries may easily be missed or neglected at the upper extremity, leading to a long-term adverse outcome with the potential need for a surgical amputation. Conclusion The present review article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating or high-velocity trauma mechanism.
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Affiliation(s)
- Jonathan T Bravman
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
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44
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McCann PA, Barakat MJ, Wand JS. Delayed brachial plexus compression secondary to anterior shoulder dislocation—The late consequence of an axillary artery pseudoaneurysm: A case report. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.injury.2006.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Da Costa-Silva S, Bessereau J, Ricard-Hibon A, Juvin P, Marty J. [Haemorrhagic shock after severe blunt shoulder trauma]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:561-2. [PMID: 15904739 DOI: 10.1016/j.annfar.2005.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2004] [Accepted: 02/03/2005] [Indexed: 05/02/2023]
Abstract
The management of severe injured patients requires life-threatening lesions research, especially potential haemorrhagic lesions. The haemorrhagic shock is a rare but serious complication of shoulder girdle traumas. We report in this study the clinical and paraclinical signs that lead us to take care from such evolution.
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Affiliation(s)
- S Da Costa-Silva
- Service d'anesthésie-réanimation et du Smur, hôpital Beaujon, 100 boulevard du Général-Leclerc, 92110 Clichy, France.
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