Rupture of the axillary artery complicating dislocation of the shoulder. Report of a case.

An obese man, aged seventy-four, fell on the outstretched hand in February 1956. Clinical and radiological examination an hour later showed subcoracoid dislocation of the right shoulder. Since the injury he had noticed that the right hand was white and cold and that there was no movement in the wrist or fingers. There was no palpable pulsation in the brachial, radial or ulnar arteries. An obvious haematoma was present in the axilla. There was a history of a severe myocardial infarction two years previously. Under general anaesthesia, two hours after the injury, the dislocation was reduced easily. On recovery from the anaesthetic he felt considerable relief from the shoulder pain but there was no improvement in the circulation of the hand. The haematoma in the axilla continued to enlarge, spreading downwards on the thoracic wall as far as the fifth rib. The general condition deteriorated steadily, due to increasing blood loss. As the limb remained white and cold, it was obvious that there was a serious injury of the axillary artery. Operation-Four and a half hours after the accident wide exposure was obtained by separation of the deltoid and the pectoralis major and by division of the tendon of the latter. On evacuation of the haematoma there was a sudden, severe gush of blood which was easily controlled by digital pressure over the proximal part of the axillary artery. It was now seen that the third part of the axillary artery had been severed completely and that the two ends were separated widely, there being a little bleeding from the distal end. The entire artery was rigid and inelastic from advanced arteriosclerosis : it appeared almost