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Pseudoaneurysm of brachial artery complicating closed fracture of humerus with triple nerve palsy
JCPSP-Journal of the College of Physicians and Surgeons Pakistan. 2001; 11 (6): 402-404
in English | IMEMR | ID: emr-57066
ABSTRACT
Pseudoaneurysm of brachial artery after blunt trauma is quite rare. We report a patient with pseudoaneurysm of brachial artery complicating closed fracture of the humerus with triple nerve palsy [median, ulnar and radial]. This is the first ever reported case involving all the three nerves. A disabled 58 years old female patient, who was wheel chair- bound, fell and suffered a closed mid shaft fracture of the left humerus. She was initially managed with a collar and cuff that was changed after one week to a POP back slab. At five weeks post-injury, radiographs revealed further displacement of the fracture and the back slab was changed to hanging POP cast. No neurovascular deficit was noted at this time. Two weeks later, the patient complained of decrease sensation over the dorsum of hand and reduced wrist extension. On review three weeks later i.e. 11 weeks after the injury, examination revealed a continued hematoma at fracture site, a radial nerve palsy and decreased sensation over the ring and little fingers but no vascular deficit. She was referred for nerve conduction studies and two weeks later dusky discoloration with signs of increasing paralysis in the hand prompted removal of cast. Examination revealed a 15 x 20 cm non-pulsatile mass on the antero-lateral aspect of the arm with no demonstrable bruit or thrill. Neither the radial nor ulnar arterial pulses were palpable and there appeared to be a complete palsy of the radial, median and ulnar nerves. The patient was taken to the operating theatre for exploration and internal fixation. An antero-lateral incision made was extended proximally and distally. A large hematoma was evacuated [fist size cavity]. A posterior defect in the brachial artery was found to communicate with the hematoma [a pseudoaneurysm]. Deep dissection revealed compression of the median and ulnar nerves. The distal humerus fragment appeared to be compromising the radial nerve. All nerves were in good condition. The humerus fracture was fixed with an AO plate. A cephalic vein graft was used to repair the brachial artery after excision of the damaged segment. At the end of the operation the hand color restored with weak radial and ulnar pulse. Postoperative recovery was uneventful and the patient was discharged 10 days after surgery. Postoperative physiotherapy was arranged and wrist splint provided. At 9 months follow-up both radial and ulnar pulses were palpable. Nerve conduction study shows recovery on a steady improvement curve. The patient is still using a splint and will require more physiotherapy input
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Index: IMEMR (Eastern Mediterranean) Main subject: Radial Nerve / Ulnar Nerve / Brachial Artery / Aneurysm, False / Fractures, Closed / Median Nerve / Nerve Compression Syndromes Type of study: Case report Limits: Female / Humans Language: English Journal: J. Coll. Physicians Surg. Pak. Year: 2001

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Index: IMEMR (Eastern Mediterranean) Main subject: Radial Nerve / Ulnar Nerve / Brachial Artery / Aneurysm, False / Fractures, Closed / Median Nerve / Nerve Compression Syndromes Type of study: Case report Limits: Female / Humans Language: English Journal: J. Coll. Physicians Surg. Pak. Year: 2001