Axillary artery lesions from humeral neck fracture: A study in relation to repair

Zhang,Quan; Wang,Shilong; Tang,Chaoliang; Chen,Wenjun; Zhang,Ye; Chen,Lin

doi:10.3892/etm.2012.775

Axillary artery lesions from humeral neck fracture: A study in relation to repair

Authors:
- Quan Zhang
- Shilong Wang
- Chaoliang Tang
- Wenjun Chen
- Ye Zhang
- Lin Chen
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Affiliations: Department of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China, Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
Published online on: October 30, 2012 https://doi.org/10.3892/etm.2012.775
Pages: 328-332

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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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