Amputation for upper extremity ischemia following shoulder dislocation: case report and a review of literature

Address for correspondence: Murat Songur, MD, Department of Orthopedics & Traumatology, Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey e-mail: [email protected] Received: 20.11.2014; Accepted: 02.02.2015: Published Online:04.07.2015 Axillary arterial injuries following blunt shoulder trauma are rare but also well reported, of which might end up with catastrophic results, if not properly diagnosed and treated. Mechanisms of arterial injury are reported as intimal tears, artery lacerations or avulsions, penetrating trauma or tethering between fracture fragments. There are several published reports of axillary artery injury following shoulder dislocations and proximal humeral fractures [1-6]. In this report we present a misdiagnosis of an axillary arterial injury case following shoulder dislocation resulting with mid humeral amputation. Also we aim to highlight the importance of neurovascular monitorization in the treatment of shoulder injuries. A 45-year-old male was admitted to emergency department of another institution following a right anterior-inferior shoulder dislocation with tuberculum majus fracture during a motor vehicle accident. Closed reduction of glenohumeral joint was performed on emergency department under sedation and shoulder was immobilized in a Velpeau bandage. Two days after reduction patient was referred to our clinic with symptoms and signs of total paralysis of right upper extremity and ischemia. Fluoroscopic image shows a well reduced joint with minimally displaced fracture of greater tuberosity (Figure 1). Patient declared that, he was unable to use his extremity, right after initial trauma. He also stated that, there was no improvement of pain following reduction. Also, there was no Injury of the axillary artery following glenohumeral dislocation is a very rare situation. The mechanisms for arterial injuries are lacerations, rupture, avulsion of main branches or intimal tears and pseudo aneurysm formations. In this report we present an upper extremity ischemia following shoulder dislocation resulting with loss of extremity. Our aim was to highlight the importance of the third part of axillary artery and consequences of underestimation of vascular pathologies following shoulder injuries. ABSTRACT