DÄ internationalArchive40/2018Traumatic Dissection of the Brachial Artery as the Result of a Proximal Humerus Fracture

Clinical Snapshot

Traumatic Dissection of the Brachial Artery as the Result of a Proximal Humerus Fracture

Dtsch Arztebl Int 2018; 115: 665. DOI: 10.3238/arztebl.2018.0665

Wurm, M; Kirchhoff, C; Zyskowski, M

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3D volume rendering of the CT angiography of the proximal humerus fracture and the traumatic dissection of the brachial artery (arrows)
3D volume rendering of the CT angiography of the proximal humerus fracture and the traumatic dissection of the brachial artery (arrows)
Figure
3D volume rendering of the CT angiography of the proximal humerus fracture and the traumatic dissection of the brachial artery (arrows)

A 79-year-old woman was brought to our surgical emergency department by ambulance after tripping and falling on her left side. She presented with pain in the left shoulder and weak peripheral pulses in the left upper extremity (radial artery, ulnar artery). There was also hypesthesia in the area supplied by the ulnar nerve (digits (IV and V).

Conventional radiography of the left shoulder showed a proximal fracture of the humerus. CT angiography of the left upper extremity, carried out because of the clinical findings, revealed traumatic dissection of the brachial artery in the fracture zone.

The patient was immediately taken to the operating room for treatment by an interdisciplinary team (vascular surgery, trauma surgery). Access was gained via an extended deltopectoral incision. The brachial artery was repaired using an interposition graft, while the fracture was managed by internal plate fixation.

Postoperatively the peripheral pulses were stronger and the hypesthesia was in regression. Five days after surgery the patient was discharged with intact peripheral perfusion and normal motor and sensory function.

Dr. med. Markus Wurm, Dr. med. Michael Zyskowski, Prof. Dr. med. Chlodwig Kirchhoff,
Abteilung und Poliklinik für Unfallchirurgie, Klinikum Rechts der Isar, Technische Universität München, Chlodwig.Kirchhoff@mri.tum.de

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare

Cite this as: Wurm M, Zyskowski M, Kirchhoff C: Traumatic dissection of the brachial artery as the result of a proximal humerus fracture. Dtsch Arztebl Int 2018; 115: 665. DOI: 10.3238/arztebl.2018.0665

3D volume rendering of the CT angiography of the proximal humerus fracture and the traumatic dissection of the brachial artery (arrows)
3D volume rendering of the CT angiography of the proximal humerus fracture and the traumatic dissection of the brachial artery (arrows)
Figure
3D volume rendering of the CT angiography of the proximal humerus fracture and the traumatic dissection of the brachial artery (arrows)