Posterolateral dislocation of the elbow with thrombosis of the brachial artery: A case report

Abstract text (incl. references and figure legends)

Case history:

A 57-year-old woman with history of CKD and kidney transplant, undergoing dialysis treatment that required an arteriovenous fistula in her right upper limb, in which she suffered a trauma after a fall with her arm extended.

Clinical findings:

She presented a deformity in her right elbow associated with limited extension of the wrist and thumb and weak distal pulses.

Investigations/Results:

The radiograph showed a posterolateral elbow dislocation. Closed reduction was performed and elbow stability was verified. The patient manifested intense pain and coldness in the distal upper limb with no evidence of distal pulses on examination. An assessment was made with Vascular Surgery without detecting pulse by echo-Doppler. Angio-CT scan showed thrombosis of the distal region of the brachial artery.

Diagnosis:

Posterolateral elbow dislocation with thrombosis of the brachial artery.

Therapy and Progressions:

An urgent intervention was performed by catheter thrombectomy and repair with an allogeneic pericardium patch, with recovery of pulses. After the intervention an elbow orthosis was placed and rehabilitation was started one month later. After two years of follow-up, the patient has recovered a complete range of motion except 20º and has had no more vascular episodes in this limb.

Comments:

Brachial artery thrombosis associated with a simple elbow dislocation is very rare. If after closed reduction there is evidence of absence of distal pulses and symptoms of acute ischemia, it is mandatory to perform complementary tests such as an echo-Doppler, more accessible, or angio-CT, the gold standard. If acute limb ischemia is confirmed, surgical exploration is required to repair the injury and restore distal blood flow.

References:

Marcheix, B., Chaufour, X., Ayel, J., Hollington, L., Mansat, P., Barret, A., Bossavy, J.P. (2005). Transection of the brachial artery after closed posterior elbow dislocation. Journal of vascular surgery, 42(6), 1230-1232.

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