Complex Posterior Elbow Dislocation Causing Complete Brachial Artery Transection. A Rare Complication of a Common Orthopedic Injury

Introduction: Brachial artery transection is a rare complication of both open and closed elbow dislocation and usually associated with anterior dislocations and penetrating injuries. Only isolated cases are reported in literature. We report an interesting case of a complex posterior elbow dislocation resulting in transected brachial artery.

Case Report: A 37 year old male was brought in following an ATV (All Terrain Vehicle) crash. Clinical examination revealed left upper extremity deformity at the elbow and humerus. X-ray revealed an acutely displaced and angulated mid left humeral fracture along with a posterior elbow dislocation. CT 3D angiogram revealed occlusion 5cm in length with reconstitution of the distal brachial artery at the level of the elbow joint. Closed reduction of the elbow along with ORIF of the humerus and a saphenous venous graft was used to repair the transected brachial artery.

Conclusion: Vascular injuries associated with posterior elbow dislocations are rare. Rich collateral circulation around the joint can mask signs of acute arterial disruption, hence repeated high index of suspicion, serial clinical examinations, appropriate imaging and prompt intervention is warranted.

Keywords: Brachial artery, Elbow dislocation, Vascular transection.