Axillary artery injury with proximal humerus epiphyseal separation: a rare case report
A 14 year old boy was referred to the hospital with pain, tenderness and deformity of the left shoulder following a motor vehicle accident. The results of a general physical examination were normal except for the left arm, where the examination revealed pain, tenderness, and swelling in the left shoulder. The range of motion on the left shoulder was severely limited. Distal radial, ulnar and brachial pulses were not palpable and could not be detected by Doppler sonography despite the behavior of the normothermic the extremity. Capillary refill times were 4 seconds in the left and 3 seconds in the right arm. The patient was unable to extend his wrist, thumb or fingers.\nThe injury was closed and there was no ecchymosis. Radiography of the left shoulder revealed a Salter-Harris type I proximal humeral epiphyseal separation ().\nClosed reduction of the physeal injury was performed in the operating room under general anesthesia to reduce compression on the axillary artery. However, distal pulses were not palpable following the anatomic reduction and we could not detect any change in vascular status. A vascular surgeon was consulted. Angiography of the left arm revealed disruption of arterial flow in the axillary artery (). The patient was taken to the operating theatre for an arterial repair or graft. Intra-operative findings included a hematoma and arterial contusion, but no active bleeding or axillary artery laceration was not located. The axillary artery was contused and thrombosed, and the brachial plexus was intact on inspection.\nAfter resection of the contused segment of the axillary artery a reverse saphenous vein interposition graft was performed.\nThe patient was monitored for 3 days in the intensive care unit, where his radial and ulnar pulses remained palpable. The Patient was discharged with a sling and swath. After 4 weeks, radial innervated muscle weakness resolved, the sling was removed, and rehabilitation for regaing shoulder and elbow motion was started. The muscle power of wrist and hand extensors returned to normal condition after 3 months.