ELBOW DISLOCATION WITH VASCULAR INJURY: SIX CASES

Abstract

Purpose of the study: Elbow dislocation is a frequent traumatic injury. Management is well described. An associated vascular lesion is exceptional, but must be searched for systematically. We report a short series and describe our therapeutic strategy for these complicated dislocations.

Material and methods: Between 1999 and 2004, our emergency unit cared for 357 cases of elbow dislocation. For six, injury to the brachial artery was present. This series included four men and one woman, mean age 34.7 years. The causal trauma was a traffic accident for four, and a fall four two. The dislocation was open in three. The radial pulse could not be palpated in any of the patients but blood supply to the hand persisted in five. There was a clinically detected neurological deficit in three. After obtaining the necessary x-rays, the elbows were reduced in the emergency room. The radial pulse remained impalpable in all patients and arteriography was performed and revealed a rupture of the brachial artery in five and an arterial spasm in one. Vascular repair was undertaken in all six cases using an reversed venous graft. The elbow was stabilized with an external fixator in three patients. For the others, the elbow was immobilized for 21 days on average before remobilization.

Results: AT 23 months follow-up, the overall outcome has been average with a Mayo clinic score of 69.2 points. Only four elbows were functional. Only one patient had a pain free elbow. Stiff joint was the most frequent functional impairment: mean flexion was 111.7° with a 41.7° extension deficit. The blood supply to the hand was correct in all cases, but one of the graft bridges became obstructed by a thrombus, the distal vascularization being supplied by the collateral circulation. The initial neurological lesions recovered partially.

Discussion: Elbow dislocation with vascular injury is exceptional but must be systematically detected. Emergency management associates reduction of the dislocation, a vascular work-up and rapid surgical management of the elbow, using an articulated external fixator when necessary, to limit as much as possible posttraumatic stiffness.