Luxación abierta postraumática de codo con lesión vascular de la arteria braquial

Abstract

The elbow is the second most commonly dislocated joint after the glenohumeral joint. Despite this, the neurovascular lesion associated with acute traumatic dislocation of the elbow is rare.
Clinical Case: Male patient, 26 years old, is evaluated in the emergency service of the Vozandes Quito Hospital, after suffering a fall of approximately 8 meters high. In multidisciplinary assessment (Traumatology and Vascular Surgery), blunt edges of approximately 6 cm are seen in the anterior region of the left elbow with exposure of the distal epiphysis of the humerus and capillary filling of 3 seconds. Complementary radiographic studies were performed where posterior and lateral dislocation of the elbow was observed, without the presence of fractures. Once the diagnosis is established as an open dislocation of the elbow with probable vascular injury of the brachial artery, the patient is admitted to the operating room at 2 hours after the trauma. In the first instance, open dislocation reduction was performed, and subsequently the anastomosis of the proximal and distal ends of the cephalic vein graft that had been taken from the same limb.

Discussion: Elbow dislocation is one of the most common in adults and the most common in children, responsible for 10% to 25% of all elbow injuries. 90% of dislocations occur in the posterior or posterolateral direction and only 1% to 2% move previously. It is estimated that arterial lesions occur in approximately 5 to 13% of elbow dislocations, most often in cases of open or penetrating lesions. Patients present with subtle signs, such as palpable but diminished pulses, decreased capillary filling and reduced pulse oximetry readings. In the case of vascular injury, investigations such as color Doppler and arteriography help identify the type of lesion and plan its management. Vascular repair is related to the observations of the arterial lesions: direct suture in cases of clean section and total integrity of the supra and underlying arterial walls or most of the time the derivation using saphenous vein graft greater.

Conclusions: The patient had a good evolution after the ligament repair that was performed, with mobility ranges that, according to expectations, were partially diminished, however, functional.