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Su F, Tangtiphaiboontana J, Kandemir U. Management of greater tuberosity fracture dislocations of the shoulder. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:578-587. [PMID: 39157260 PMCID: PMC11329025 DOI: 10.1016/j.xrrt.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background Despite extensive literature dedicated to determining the optimal treatment of isolated greater tuberosity (GT) fractures, there have been few studies to guide the management of GT fracture dislocations. The purpose of this review was to highlight the relevant literature pertaining to all aspects of GT fracture dislocation evaluation and treatment. Methods A narrative review of the literature was performed. Results During glenohumeral reduction, an iatrogenic humeral neck fracture may occur due to the presence of an occult neck fracture or forceful reduction attempts with inadequate muscle relaxation. Minimally displaced GT fragments after shoulder reduction can be successfully treated nonoperatively, but close follow-up is needed to monitor for secondary displacement of the fracture. Surgery is indicated for fractures with >5 mm displacement to minimize the risk of subacromial impingement and altered rotator cuff biomechanics. Multiple surgical techniques have been described and include both open and arthroscopic approaches. Strategies for repair include the use of transosseous sutures, suture anchors, tension bands, screws, and plates. Good-to-excellent radiographic and clinical outcomes can be achieved with appropriate treatment. Conclusions GT fracture dislocations of the proximal humerus represent a separate entity from their isolated fracture counterparts in their evaluation and treatment. The decision to employ a certain strategy should depend on fracture morphology and comminution, bone quality, and displacement.
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Affiliation(s)
- Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Utku Kandemir
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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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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Wright B, Gutowski C, Fedorka CJ. A proximal humerus fracture with concomitant axillary artery occlusion and axillary nerve palsy treated with reverse total shoulder arthroplasty: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:529-533. [PMID: 37928998 PMCID: PMC10624990 DOI: 10.1016/j.xrrt.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Branden Wright
- Cooper Bone and Joint Institute, Cooper University Hospital, Camden, NJ, USA
| | - Caroline Gutowski
- Department of Orthopaedics, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Catherine J. Fedorka
- Cooper Bone and Joint Institute, Cooper University Hospital, Camden, NJ, USA
- Department of Orthopaedics, Cooper Medical School of Rowan University, Camden, NJ, USA
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Di Giacomo LM, Marzano F, Zaganelli A, Pace V, Petruccelli R, Rinonapoli G, Caraffa A. Two stage treatment of a proximal humeral fracture-dislocation with vascular injury: Case report of a multidisciplinary approach. Trauma Case Rep 2021; 36:100547. [PMID: 34765715 PMCID: PMC8569709 DOI: 10.1016/j.tcr.2021.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Proximal humeral fracture-dislocation associated with neurovascular injury is rare events, associated with poorer outcomes and higher risk of complications. A multidisciplinary approach including the orthopaedic and vascular department is essential in treating such kind of injury. The goal of the treatment is to restore the vascular supply and stabilize the fracture. Usually the orthopaedic surgical stabilization provides a stable substrate for the vascular repair. We report a case of 70 years old woman who sustained a 4 part proximal humerus fracture-dislocation with vascular injury at the level of the transition of the subclavian into axillary artery. Because of the impending severe limb ischemia, the priority of the treatment was given to vascular surgical intervention with a by-pass procedure. After 14 days a reverse shoulder prosthesis was thought to be the best alternative in the second stage surgery. At 18 months follow-up we achieved good clinical and radiological outcomes. Although a lack of consensus on the priority of treatments, we achieved good result following our proposed algorithm of treatment.
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Affiliation(s)
- Lorenzo Maria Di Giacomo
- Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy
| | - Fabrizio Marzano
- Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy
| | - Andrea Zaganelli
- Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy
| | - Valerio Pace
- Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy
| | - Rosario Petruccelli
- Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy
| | - Giuseppe Rinonapoli
- Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy
| | - Auro Caraffa
- Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy
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Kim AE, Chi H, Swarup I. Proximal Humerus Fractures in the Pediatric Population. Curr Rev Musculoskelet Med 2021; 14:413-420. [PMID: 34709578 DOI: 10.1007/s12178-021-09725-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to review recent literature focusing on proximal humerus anatomy, epidemiology of these fractures, diagnosis and treatment options, and clinical outcomes. RECENT FINDINGS Non- or minimally displaced proximal humerus fractures treated nonoperatively do not lead to short- or long-term complication and do not cross over to operative treatment. There is a higher rate of operative management with older age, increased injury severity score, treatment at an adult hospital, and private insurance. Operative management is preferred with closed or open reduction and percutaneous pinning, but elastic nailing and plate fixation are other options with good postoperative outcomes. Pediatric proximal humerus fractures occur after fall onto the affected shoulder or arm. Diagnosis is usually made with radiographs. Understanding the proximal humerus anatomy is critical to the proper management of these injuries to aid reduction and predict remodeling potential. There is considerable debate around the management of proximal humerus fractures in the pediatric population. Treatment is based on patient age, fracture displacement, and remodeling capacity. Nonoperative management is successful in younger patients or less displaced fractures, and operative management is usually considered in older patients with more displaced fractures.
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Affiliation(s)
- Arin E Kim
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Hannah Chi
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA. .,University of California, San Francisco, 747 52nd Street, OPC First Floor, Oakland, CA, 94609, USA.
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Yang K, Lee H, Choi IJ, Jeong W, Kim HT, Wei Q, Lee JH. Topography and Anatomical Variations of the Axillary Artery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6393780. [PMID: 34124252 PMCID: PMC8169239 DOI: 10.1155/2021/6393780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/07/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
Knowledge of anatomical variations of the limb's main arteries is significant for the clinicians. Thus, this study is aimed at examining the branching pattern and anatomical variations of the axillary artery. We conducted research on 59 upper limbs of adult human donated cadavers. All axillary artery branches' origins were assessed, and the correlations between points of origins and variations of specific branches were evaluated. The average length of the axillary artery was found to be 11.22 cm, and this length was defined as reference line. Based on this reference line, the first, second, and third parts were 37.56%, 39%, and 30.05%, respectively. The STA was originated from 25.11%. The TAA and LTA were 42.67% and 54.82%, respectively. The SSA, ACHA, and PCHA were 64.72%, 83.89%, and 84.53%, respectively. The origin of LTA was correlated with that of SSA (R = 0.473, P < 0.05) and AHCA (R = 0.307, P < 0.05), respectively. And there was a positive correlation between AHCA and PHCA (R = 0.705, P < 0.05). The number of branches ranged from 3~6, and 9 types were shown. The most frequent branching pattern was common origin of the LTA and SSA (22/59). And AHCA and PHCA were originated together in 19 cases, and both patterns were combined in 12 cases. TTA and LTA branched together in 9 cases, and common trunk for the SSA, PHCA, and AHCA was found in 2 cases. According to this pattern, the origin of LTA and PCHA was significantly different. This information is particularly useful for surgeons and clinicians.
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Affiliation(s)
- Kiwook Yang
- Department of Anatomy, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hyunsu Lee
- Department of Anatomy, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - In-Jang Choi
- Department of Anatomy, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Hong-Tae Kim
- Department of Anatomy, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Qun Wei
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Jae-Ho Lee
- Department of Anatomy, School of Medicine, Keimyung University, Daegu, Republic of Korea
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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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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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[Reduction techniques for minimally invasive stabilization of proximal humeral fractures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:63-80. [PMID: 30683977 DOI: 10.1007/s00064-018-0586-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of surgical stabilization of proximal humerus fractures is to restore the anatomical relations between the greater and lesser tubercle, to reconstruct the joint and preserve the vascular supply of the fragments. INDICATIONS Approximately 80% of proximal humeral fractures can be treated conservatively. Surgical treatment is indicated based on the fracture pattern, patient-related factors and the risk of avascular head necrosis. Two-part fractures with a metaphyseal comminution zone and 3/4-part fractures can benefit from near to anatomic reconstruction depending on the patient's demands and bone quality. Minimally invasive stabilization procedures allow for an anatomical reconstruction in the majority of fresh proximal humeral fractures with or without a proximal shaft fracture, provided that intraoperative traction allows the fracture to be aligned axially in the image intensifier by ligamentotaxis. Indirect, combined with direct reduction maneuvers, allow for an almost anatomical reconstruction, despite minimal invasive approaches. SURGICAL TECHNIQUE Beach chair position. The arm is held in a pneumatic articulating traction device. Evaluation of the indirect reduction potential by ligamentotaxis with visualization of the alignment of the head fragments in relation to the shaft by traction, abduction/adduction, flexion/extension and rotation. The traction device and a foam roll in the axilla to neutralize the tension of the pectoralis major and teres major muscles while simultaneously adducting the elbow hold the reduction. Insufficient reduction of the fragments requires additional direct reduction maneuvers. Opening of the bursa and fixation of the rotator cuff with sutures to adjust reposition. A 2.5 mm-threaded K‑wire is inserted into the head fragment as a joystick. Under protection of the axillary nerve, the plate is inserted under protection of the axillary nerve. Temporary fixation of the plate with Kirschner wires for positioning the plate 5-8 mm below the greater tubercle and 2-3 mm laterally of the sulcus of the long biceps tendon and subsequent radiographic control. Reduction of the shaft against the plate with a cortex screw. The threaded K‑wire in the head can be used to adjust the varus and valgus alignment and to achieve adequate support of the calcar. Finally, complete the osteosynthesis with angular stable screws. POSTOPERATIVE MANAGEMENT Immediate active assisted exercise in the shoulder under physiotherapeutic supervision. Temporary immobilization for patient comfort. Standard active and resistive mobilization after the first clinical and radiological checkup 6 weeks after surgery. Further radiological checks after 3 and 6 months and 1 year. No routine plate removal.
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Karita Y, Kimura Y, Sasaki S, Nitobe T, Tsuda E, Ishibashi Y. Axillary artery and brachial plexus injury secondary to proximal humeral fractures: A report of 2 cases. Int J Surg Case Rep 2018; 50:106-110. [PMID: 30098526 PMCID: PMC6089080 DOI: 10.1016/j.ijscr.2018.04.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/30/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Axillary artery and brachial plexus injuries have been reported to be associated with proximal humeral fractures. In this report, we present two cases of axillary artery and brachial plexus injury secondary to proximal humeral fracture. PRESENTATION OF CASES Case 1: An 88-year-old woman with cognitive impairment slipped and fell at home. The diagnosis was left proximal humeral fracture. The second day, paralysis of left upper arm due to left axillary artery occlusion appeared. Axillary-brachial artery bypass surgery was performed. After that, a radial artery pulse was palpable. Ten months have passed since the operation, but the neurologic deficit has not been restored. Case 2: A 74-year-old woman fell from a ladder. She was diagnosed with a right proximal humeral fracture and right axillary artery occlusion. Emergency axillary-brachial bypass surgery and osteosynthesis were performed. After reestablishing the blood flow, there have been no signs of blood flow disorders but paralysis has remained. DISCUSSION In neither of the two cases, were obvious findings of brachial plexus injury detected during surgery. The delayed onset of motor palsy implied that an ischemic factor was implicated in case 1. The acute onset of motor palsy might have been caused by a mechanical factor such as the dislocated of humeral head in case 2. CONCLUSION Axillary artery and brachial plexus injury secondary to proximal humeral fracture is rare but it can develop severe sequels. By identifying the high-risk patients, diagnosis and management of this vascular and plexus injury might lead to improvement.
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Affiliation(s)
- Yukiko Karita
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taisuke Nitobe
- Department of Orthopaedic Surgery, Tsugaru General Hospital, Goshogawara, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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11
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Kurowicki J, Triplet JJ, Berglund DD, Zink T, Rosas S, Levy JC. Use of a Reverse Shoulder Arthroplasty Following a Fracture-Dislocation with a Brachial Plexus Palsy: A Case Report. JBJS Case Connect 2018; 8:e36. [PMID: 29901477 DOI: 10.2106/jbjs.cc.17.00204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An 80-year-old woman sustained a fracture-dislocation of the proximal aspect of the humerus with a near-complete brachial plexopathy, which was successfully managed acutely using a reverse shoulder arthroplasty (RSA) with repair of the greater and lesser tuberosities. The palsy, which was confirmed with nerve conduction studies, recovered uneventfully along with functional improvement of the shoulder. At the most recent follow-up, there was complete resolution of the plexopathy, with excellent, pain-free range of motion. CONCLUSION Acute RSA with tuberosity repair may be a reasonable treatment modality in the setting of an acute brachial plexus palsy following a comminuted fracture-dislocation of the proximal aspect of the humerus in an elderly patient.
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Affiliation(s)
- Jennifer Kurowicki
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey
| | | | | | | | - Samuel Rosas
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
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12
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Githens M. Life-Threatening Hemorrhage from an Unrecognized Axillary Vein Injury During Treatment of a Proximal Humeral Fracture-Dislocation with a Known Axillary Artery Injury: A Case Report. JBJS Case Connect 2018; 8:e33. [PMID: 29794488 DOI: 10.2106/jbjs.cc.17.00156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 57-year-old man presented with bilateral proximal humeral fracture-dislocation and an associated axillary artery injury. He was treated urgently with reduction, arterial repair, fasciotomies, and skeletal stabilization. The patient sustained a massive intraoperative hemorrhage from an unrecognized axillary vein injury after the arterial repair. CONCLUSION An unrecognized axillary vein injury led to substantial blood loss that required a massive transfusion protocol. Although an axillary arterial injury is readily identified with computed tomography angiography, concomitant venous injuries may go unrecognized. The surgical team, including the vascular and orthopaedic surgeons and the anesthesiologists, should be prepared to manage a life-threatening hemorrhage.
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Affiliation(s)
- Michael Githens
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington
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13
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Mehta VM, Mandala CL, Shriver RJ, Shah R. Proximal humeral fracture-dislocation with axillary artery involvement treated with reverse shoulder arthroplasty. JSES OPEN ACCESS 2018; 2:100-103. [PMID: 30675575 PMCID: PMC6334852 DOI: 10.1016/j.jses.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Rachit Shah
- Fox Valley Orthopaedic Institute, Geneva, IL, USA
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14
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Singh AK, Rudge W, Quick T. An important lesson in assessing neurovascular involvement in proximal humeral fractures: the presence of neuropathic pain in a dysvascular limb. J Shoulder Elbow Surg 2018; 27:e20-e24. [PMID: 29221576 DOI: 10.1016/j.jse.2017.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Ashok K Singh
- Department of Trauma & Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK.
| | - William Rudge
- Shoulder and Elbow Unit, Royal National Orthopaedic Hospital, Stanmore, Middx, UK
| | - Tom Quick
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, Middx, UK
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15
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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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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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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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Chen YX, Zhu Y, Wu FH, Zheng X, Wangyang YF, Yuan H, Xie XX, Li DY, Wang CJ, Shi HF. Anatomical study of simple landmarks for guiding the quick access to humeral circumflex arteries. BMC Surg 2014; 14:39. [PMID: 24970300 PMCID: PMC4099027 DOI: 10.1186/1471-2482-14-39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 06/17/2014] [Indexed: 11/21/2022] Open
Abstract
Background The posterior and anterior circumflex humeral artery (PCHA and ACHA) are crucial for the blood supply of humeral head. We aimed to identify simple landmarks for guiding the quick access to PCHA and ACHA, which might help to protect the arteries during the surgical management of proximal humeral fractures. Methods Twenty fresh cadavers were dissected to measure the distances from the origins of PCHA and ACHA to the landmarks (the acromion, the coracoid, the infraglenoid tubercle, the midclavicular line) using Vernier calipers. Results The mean distances from the origin of PCHA to the infraglenoid tubercle, the coracoid, the acromion and the midclavicular line were 27.7 mm, 50.2 mm, 68.4 mm and 75.8 mm. The mean distances from the origin of ACHA to the above landmarks were 26.9 mm, 49.2 mm, 67.0 mm and 74.9 mm. Conclusion Our study provided a practical method for the intraoperative identification as well as quick access of PCHA and ACHA based on a series of anatomical measurements.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hong-fei Shi
- Department of Orthopaedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No, 321 Zhongshan Road, Nanjing China.
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Cawich SO, Harnarayan P, Budhooram S, Naraynsingh V. Axillary Artery Injury Accompanying Humeral Neck Fracture. Int J Angiol 2014; 24:296-9. [PMID: 26648673 DOI: 10.1055/s-0034-1372246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Injuries to the axillary artery from proximal humeral fractures are uncommon. There are only 66 such injuries reported across the world literature to date. We report an additional case of axillary artery injury. This case highlights the importance of maintaining a high index of suspicion to prevent diagnostic delay.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Steve Budhooram
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
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Zhang Q, Wang S, Tang C, Chen W, Zhang Y, Chen L. Axillary artery lesions from humeral neck fracture: A study in relation to repair. Exp Ther Med 2012; 5:328-332. [PMID: 23251293 PMCID: PMC3524089 DOI: 10.3892/etm.2012.775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/22/2012] [Indexed: 11/28/2022] Open
Abstract
Whether axillary artery injuries associated with proximal humeral fractures must be repaired is uncertain. The present study reports three cases treated with various approaches. In case 1, the left humeral surgical neck was broken, the radial pulse disappeared and the arm temperature was significantly reduced. Computerized tomography angiography (CTA) revealed a 3-cm filling deficiency in the axillary artery. The injured artery was reconstructed with a segment of the greater saphenous vein after the fracture was reduced and fixed with a plate. In case 2, the axillary artery was compressed by the broken humeral segment, which caused the right hand to become cool. The fracture was fixed but the axillary artery embolism was not treated. In case 3, the humeral neck was broken with injury to the brachial plexus, although the patient’s hand remained warm. Digital subtraction angiography (DSA) revealed that the axillary artery was injured badly but there was extensive collateral circulation. The proximal humeral fracture was reduced and fixed without artery reconstruction. The three cases all resulted in a good outcome with the bone healed and limb alive. No ischemic necrosis occurred. However, the neurapraxia did not dissappear completely. Axillary artery injury resulting from humeral neck fracture is a rare but disabling traumatic event. Early diagnosis based on signs of acute ischemia of the arm enables early treatment and a favourable outcome. An angiogram is the best way to diagnose the artery injury and evaluate the condition of the collateral circulation. The injured artery in a cold arm should be repaired, while in a warm arm reconstruction is unnecessary due to rich collateral circulation.
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Marquaß B, Schiffner E, Theopold J, von Dercks N, Josten C, Hepp P. Ipsilaterale Begleitverletzungen an der oberen Extremität und des Schultergürtels nach proximalen Humerusfrakturen. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s11678-012-0172-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Seagger RM, Kitson J. A rare combination of an axillary artery and brachial plexus injury due to a proximal humeral fracture. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2011; 3:71-3. [PMID: 20671870 PMCID: PMC2907005 DOI: 10.4103/0973-6042.59975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Robin M Seagger
- The Orthopaedic Department, The Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX25DW, United Kingdom
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Abstract
Results of hemiarthroplasty for complex four-part proximal humerus fractures in the elderly have been unreliable. Although patients often achieve pain relief, return of above-shoulder level function can be challenging, because tuberosity nonunion, malunion, and/or resorption is quite common. The reverse shoulder replacement has been advocated as a reliable alternative for these patients. Preliminary studies have suggested that tuberosity healing is critical for achieving external rotation strength after reverse shoulder arthroplasty. We describe a technique of tuberosity repair using a wedge horseshoe graft, which can provide improved surface area for tuberosity healing. A clinical series of seven patients treated with this technique is reported with a minimum follow-up of 12 months (range, 12-23 months). The tuberosity union rate was 86% (six of seven patients). Average active forward elevation was 117° (range, 95°-150°), and active external rotation was 19° (range 0°-30°). Visual analog scale pain scores averaged 0.6 (range, 0-1), visual analog scale function averaged 8.7 (range, 7-10), mean American Shoulder and Elbow Surgeons pain was 47.1 (range, 45-50), and mean American Shoulder and Elbow Surgeons function was 39.2 (range, 31-50). Subjective satisfaction ratings were excellent for four patients, and good for two, and satisfactory for one. No patients were unsatisfied with their outcomes. The horseshoe graft technique provides a reliable means for anatomic restoration of the tuberosities, facilitating the return of shoulder function in elderly patients with complex four-part proximal humerus fractures treated with a reverse total shoulder.
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Reverse shoulder replacement compared with hemiarthroplasty for proximal humeral fractures. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181e893d2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gorthi V, Moon YL, Jo SH, Sohn HM, Ha SH. Life-threatening posterior circumflex humeral artery injury secondary to fracture-dislocation of the proximal humerus. Orthopedics 2010; 33. [PMID: 20349876 DOI: 10.3928/01477447-20100129-29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Proximal humeral fractures account for 4% to 5% of all fractures, and most of these are minimally displaced and less prone to neurovascular injuries. This article presents a case of a 65-year-old man who injured the posterior circumflex humeral artery following a fracture dislocation of the proximal humerus leading to a life-threatening hemorrhagic complication during surgical fixation of the dislocated proximal humeral fracture. Preoperative vital signs were normal. Using the deltopectoral approach, the fracture site was exposed and the dislocated head was extracted. Blood pooled and overflowed the cavity at a brisk pace. Blood pressure dropped from 130/70 mm Hg to 90/45 mm Hg, and preoperative follow-up hemoglobin dropped to 4.8 g/dL. The axillary artery was explored and a ruptured posterior humeral circumflex artery was observed that was later ligated. In view of the damage to 1 of the circumflex humeral branches, primary hemiarthroplasty was performed. This article highlights the possibility of encountering life-threatening vascular injuries in highly displaced or dislocated 4-part proximal humeral fractures and the significance of obtaining the angiographic studies early in the course of management in such cases.
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Affiliation(s)
- Venkat Gorthi
- Department of Orthopedics, Chosun University Hospital, Gwangju, South Korea
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Sandiford N, Tsitskaris K, Erritty M. Delayed presentation of a pseudoaneurysm of the subclavian and axillary artery--the importance of vigilance. J R Soc Med 2010; 103:67-9. [PMID: 20118337 DOI: 10.1258/jrsm.2009.090454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nemandra Sandiford
- Department of Trauma and Orthopaedic Surgery Queen Mary's Hospital, Sidcup, Kent DA14 6LR, UK.
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28
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Reverse Shoulder Prosthesis for Acute Four-Part Fracture. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2009. [DOI: 10.1097/bte.0b013e3181a598ae] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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30
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Modi CS, Nnene CO, Godsiff SP, Esler CNA. Axillary artery injury secondary to displaced proximal humeral fractures: a report of two cases. J Orthop Surg (Hong Kong) 2008; 16:243-6. [PMID: 18725681 DOI: 10.1177/230949900801600223] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report 2 cases of axillary artery injury secondary to low-energy proximal humeral fractures. In case 1, early diagnosis based on signs of acute ischaemia of the arm enabled early treatment and a favourable outcome. In case 2, there were no signs of ischaemia or neurological deficit, resulting in delayed diagnosis and increased severity of the injury. The patient developed a false aneurysm and sepsis and eventually died. A high index of suspicion is necessary for diagnosing an axillary artery injury. We recommend that all patients with proximal humeral fractures with severe medial displacement of the shaft and a bone spike should routinely undergo Doppler ultrasound scanning to rule out vascular injuries and the presence of a false aneurysm.
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Affiliation(s)
- C S Modi
- Warwick Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom.
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31
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Acute renal failure due to rhabdomyolysis after proximal humerus fracture associated with axillary artery rupture. Int Urol Nephrol 2008; 40:855-8. [PMID: 18587662 DOI: 10.1007/s11255-008-9341-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 01/13/2008] [Indexed: 12/15/2022]
Abstract
The anatomical proximity of axillary artery to the humeral head makes it quite vulnerable to blunt trauma during shoulder injury. Axillary artery rupture and prolonged ischemia may lead to rhabdomyolysis and acute renal failure. Herein we present a case of a patient who sustained proximal humerus fracture associated with axillary artery rupture and acute renal failure due to rhabdomyolysis.
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32
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Gallucci G, Ranalletta M, Gallucci J, De Carli P, Maignon G. Late onset of axillary artery thrombosis after a nondisplaced humeral neck fracture: a case report. J Shoulder Elbow Surg 2006; 16:e7-8. [PMID: 17118676 DOI: 10.1016/j.jse.2006.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 04/12/2006] [Indexed: 02/01/2023]
Affiliation(s)
- Gerardo Gallucci
- Instituto de Ortopedia y Traumatologia, Carlos E. Ottolenghi Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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33
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Wera GD, Friess DM, Getty PO, Armstrong DG, Lacey SH, Baele HR. Fracture of the proximal humerus with injury to the axillary artery in a boy aged 13 years. ACTA ACUST UNITED AC 2006; 88:1521-3. [PMID: 17075102 DOI: 10.1302/0301-620x.88b11.18164] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fractures of the proximal humerus with concomitant vascular injury are rare in children. We describe the presentation, diagnosis, and treatment of a fracture of the proximal humerus in association with an axillary artery injury in a child.
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Affiliation(s)
- G D Wera
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, USA.
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Barvencik F, Gebauer M, Janssen A, Ismail M, Rupprecht M, Rueger JM, Briem D. [Prolonged vascular complications with subsequent finger necrosis after humeral head luxation fracture in the elderly]. Unfallchirurg 2006; 110:78-85. [PMID: 16932905 DOI: 10.1007/s00113-006-1145-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fractures of the proximal humerus represent a typical injury of the elderly. Additional lesions of nerves or arteries are rare and there is only little information in the literature on the co-occurrence of proximal humerus fractures and compromised peripheral circulation which could lead to the loss of the upper extremity. To prevent damage to the injured limb, it is necessary to invent and initiate a standardized algorithm involving trauma care matching the special needs of this combined injury.
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Affiliation(s)
- F Barvencik
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Zentrum für Operative Medizin, Universitätsklinikum Hamburg-Eppendorf, 20246 Hamburg.
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Affiliation(s)
- A A Syed
- Department of Orthopaedics, York District Hospital, Wigginton Road, Y031 8HE, York, UK.
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Dinkel HP, Eckstein FS, Triller J, Do DD. Emergent Axillary Artery Stent-Graft Placement for Massive Hemorrhage From an Avulsed Subscapular Artery. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0129:eaasgp>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dinkel HP, Eckstein FS, Triller J, Do DD. Emergent axillary artery stent-graft placement for massive hemorrhage from an avulsed subscapular artery. J Endovasc Ther 2002; 9:129-33. [PMID: 11958317 DOI: 10.1177/152660280200900121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the successful endovascular repair of an acute axillary artery hemorrhage. CASE REPORT An 87-year-old woman with Charcot-Marie-Tooth ataxia presented with an enormous shoulder hematoma and clinical signs of exsanguination after a fall. Angiography demonstrated complete avulsion of the right subscapular artery from the axillary artery, and active bleeding into a hematoma of at least 1500 mL. Endovascular repair with a balloon-mounted covered stent-graft was performed percutaneously, which controlled the bleeding and averted surgery. The patient recovered uneventfully and was without signs of recurrent bleeding or ischemia on the 6-month ultrasound examination; she reports no symptoms referable to her upper extremity after 14 months. CONCLUSIONS Endovascular repair with stent-grafts is effective in controlling arterial bleeding from supra-aortic vessels even under emergency conditions.
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Affiliation(s)
- Hans-Peter Dinkel
- Department of Radiology, Inselspital Bern, University of Bern, Switzerland.
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McFarland EG, Caicedo JC, Guitterez MI, Sherbondy PS, Kim TK. The anatomic relationship of the brachial plexus and axillary artery to the glenoid. Implications for anterior shoulder surgery. Am J Sports Med 2001; 29:729-33. [PMID: 11734485 DOI: 10.1177/03635465010290061001] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Iatrogenic brachial plexus injury is an uncommon but potentially severe complication of shoulder reconstruction for instability that involves dissection near the subscapularis muscle and potentially near the brachial plexus. We examined the relationship of the brachial plexus to the glenoid and the subscapularis muscle and evaluated the proximity of retractors used in anterior shoulder surgical procedures to the brachial plexus. Eight fresh-frozen cadaveric shoulders were exposed by a deltopectoral approach. The subscapularis muscle was split in the middle and dissected to reveal the capsule beneath it. The capsule was split at midline, and a Steinmann pin was placed in the equator of the glenoid rim under direct visualization. The distance from the glenoid rim to the brachial plexus was measured with calipers with the arm in 0 degrees, 60 degrees, and 90 degrees of abduction. The brachial plexus and axillary artery were within 2 cm of the glenoid rim, with the brachial plexus as close as 5 mm in some cases. There was no statistically significant change in the distance from the glenoid rim to the musculocutaneous nerve, axillary artery, medial cord, or posterior cord with the arm in various degrees of abduction. Retractors placed superficial to the subscapularis muscle or used along the scapular neck make contact with the brachial plexus in all positions tested.
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Affiliation(s)
- E G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
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