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      Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report

      case-report

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          Abstract

          Introduction: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes.

          Methods: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit.

          Results: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism.

          Conclusion: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary.

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          Most cited references5

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          Proximal humerus fracture with injury to the axillary artery: a population-based study.

          The available evidence regarding axillary artery injury as a result of proximal humerus fracture consists of individual case reports or small series. This study used nationally representative data to determine the prevalence and predictors of axillary artery injury secondary to proximal humerus fracture, and to characterise its influence on inpatient mortality, length of stay, cost and discharge disposition.
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            Axillary artery transection following anterior shoulder dislocation: classical presentation and current concepts.

            Injury to the axillary artery following anterior shoulder dislocation is a very rare occurrence. This review serves to illustrate the now classical case of an elderly gentleman with a recurrent dislocation, transection of the axillary artery and its invariable association with a severe brachial plexus lesion, which is the most important determinant of long-term disability. It also highlights the pathognomic triad of anterior shoulder dislocation, expanding axillary haematoma and diminished peripheral pulse, to highlight awareness of this important injury. The literature on this injury has been reviewed and recommendations for the immediate and early post-operative investigation and management have been brought up to date in line with current thinking.
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              Posterior sternoclavicular dislocation presenting with upper-extremity deep vein thrombosis.

              Posterior sternoclavicular dislocation is an uncommon injury and often remains initially undiagnosed due to variable clinical presentation and inadequate visualization of the joint on plain radiographs. It is frequently associated with serious and life-threatening injuries involving the trachea, esophagus, or great vessels. A 15-year-old boy was knocked to the ground during wrestling and landed on his left shoulder. He presented 6 days after trauma with increasing arm swelling and pain. A Doppler ultrasound revealed deep vein thrombosis involving the left shoulder and arm. Contrast-enhanced computed tomography of the chest confirmed the diagnosis of left posterior sternoclavicular dislocation with the medial end of left clavicle compressing the underlying brachiocephalic vein. Venous duplex scan confirmed acute venous thrombosis of the left jugular and subclavian veins. Open reduction of the left posterior sternoclavicular dislocation was performed under general anesthesia with cardiothoracic surgery backup. The reduced joint was stable, negating the need for internal fixation. Postoperatively, the pain and arm swelling gradually subsided, and patient recovered well with no complications. Deep vein thrombosis has not been reported as a presenting symptom for posterior sternoclavicular dislocation. Orthopedic, trauma, and thoracic surgeons should be aware of this presentation and obtain a chest computed tomography scan with 3-dimensional reconstruction to confirm the diagnosis. In cases of posterior sternoclavicular dislocation with vascular compromise, patients should immediately undergo open reduction with or without internal fixation.
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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2017
                11 January 2017
                : 3
                : ( publisher-idID: sicotj/2017/01 )
                : 3
                Affiliations
                [1 ] Vascular Surgery Unit, University Hospital of Besançon 25030 Besançon France
                [2 ] Orthopaedic, Traumatology and Hand Surgery Unit, University Hospital of Besançon 25030 Besançon France
                Author notes
                [* ]Corresponding author: bettyleclerc19@ 123456gmail.com
                Article
                sicotj160068 10.1051/sicotj/2016041
                10.1051/sicotj/2016041
                5225835
                28074775
                fc72d1b8-078c-4888-ae7c-13920addf479
                © The Authors, published by EDP Sciences, 2017

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 July 2016
                : 19 November 2016
                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 5, Pages: 3
                Categories
                Shoulder
                Case Report

                axillary injury,bilateral pulmonary embolism,anterior shoulder dislocation,neurovascular complications

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