DOI: http://dx.doi.org/10.18203/2349-2902.isj20195405

Brachial artery injury in pediatric patients: review of management and outcome in 29 patients

Shobhit Sharma, Vishwanath Pratap Singh, Sudipta Bera

Abstract


Background: The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability and commonly it is associated with road traffic accidents and occupational injuries. But brachial artery injury in pediatric age group is not very frequent as in adults and commonly associated with supracondylar fracture of humerus. They may present with or without features of ischemia. Prompt diagnosis and treatment is essential for salvage of limb in established ischemia. Obscure presentation of arterial injury poses challenge in early diagnosis and treatment. Repair of the injured artery in these cases is not clearly recommended. We are presenting a series of 29 pediatric brachial artery injuries and their outcome in our institute over the last 5 years.

Methods: Twenty nine pediatric patients with brachial artery injury managed in our institute between 2014 to 2018 are assessed retrospectively for operative procedure and outcome.

Results: Supracondylar fracture was the most common cause (55.17%). Ischemic and non-ischemic presentation was noted in 41.37% and 69.63% cases respectively. Artery repair was done in 17 (58.62%) cases. Primary repair and interposition vein graft repair was done 8 and 9 cases respectively. Among the 17 repaired artery good functional outcome with Grade 5/5 muscle power noted in 14cases. Amputation was done in two cases.

Conclusions: Good functional recovery may be achieved in segmental injury repair with a vein graft. Though in closed injury without ischemic features artery may not be repaired, full functional recovery is possible due to collateral circulations. Obscure presentation detected and repaired early also has a satisfactory result. 


Keywords


Brachial artery injury, Pediatric, Vein graft, Obscure

Full Text:

PDF

References


Ekim H. Tuncer M. Management of traumatic brachial artery injury: A report on 49 patients. Ann Saudi Med. 2009;29(2):105-9.

Stettler GR, Kemp C, Wright F, Peltz E. Delayed presentation of complete arterial transection treated with interposition graft: A case report. Trauma Case Rep. 2018;18:24-7.

Snyder A, Crick JC. Brachial artery injury in children. In J Surg Orthop Adv. 2013;22(2):105-12.

Vickash K, Amer A, Naeem A, Falak S. Brachial Artery Injury in a Child following Closed Elbow Dislocation: Case Report of a Rare Injury. Malays Orthop J. 2016;10(3):36-8.

Hill RD, Smith RB III. Examination of the Extremities: Pulses, Bruits, and Phlebitis. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990: 30.

Zellweger R, Hess F, Nicol A. An analysis of 124 surgically managed brachial artery injuries. Am J Surg. 2003;188:240-5.

Traumatic isolated brachial artery and median nerve transcection in a child. Paed oncall Jour. 2017;14(2):39-40.

Guler F, Baz A, Kose O, Cicek E, Akalin S. Delayed diagnosis of rupture of brachial artery due to closed posterior elbow dislocation. Hong Kong J Emerg Me. 2011;18(2):112.

Stettler GR, Kemp C, Wright F, Peltz E. Delayed presentation of complete arterial transection treated with interposition graft: A case report. Trauma Case Rep. 2018;18:24-7.

Kumar JBC, Sampath D, Reddy HN, Motukuru V. Complete Brachial Artery Transection following closed Posterior Elbow Dislocation: A Rare Case Report. J Orthop Case Reports. 2015;5(4):27-9.

Noaman H. Microsurgical reconstruction of brachial artery injury in displaced supracondylar fracture humerus in children. Microsurgery. 2006;26(7):498-505.

Matuszewski L. Evaluation and management of pulseless pink/pale hand syndrome coexisting with supracondylar fractures of humerous in children. Eur J Orthop Surg Traumatol. 2014;24:1401-6.

Taub PJ, Giannikis G, Shen HY, Kim U.Brachial artery transcection following closed elbow dislocation. J Trauma. 1999;47:176-8.

Complete Brachial Artery Injury After open elbow dislocation: A case report. Euro Med Bio Jar. 2019;14(04):17-9.

Ramachandran M, Birch R, Eastwood DM (2006) Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: the experience of a specialist referral centre. J Bone Joint Surg Br. 2006;88:90-4.

Miller-Thomas MM, West OC, Cohen AM. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics. 2005;25 Suppl 1:S133-42.

Wolfswinkel EM, Weathers WM, Siy RW, Horowitz KS, Hollier LH Jr.Less is more in the nonoperative management of complete brachial artery transection after supracondylar humeral fracture. Ann Vasc Surg. 2014;28(3):739.e11-6.

Alves K, Spencer H, Barnewolt CE, Waters PM, Bae DS. Early Outcomes of Vein Grafting for Reconstruction of Brachial Arterial Injuries in Children. J Hand Surg Am. 2018;43(3):287.e1-7.

Kim HG, Bhatia MB, Moore SA, Fitzwater JW, Santana D. Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child. J Pediatr Surg Case Reports. 2017;19:16-8.

Lewis HG, Morrison CM, Kennedy PT, Herbert KJ. Arterial reconstruction using the basilica vein from the zone of injury in pediatric supracondylar fracture: a clinical and radiological series. Plast Reconstr Surg. 2003;111:1159-63.

Sharma D, Yadav RK. A rare case of traumatic brachial artery injury. Int Surg J. 2016;2(4):732-4.

Moini M. Outcome of delayed brachial artery repair in patients with traumatic brachial artry injury: Prospective study. Int Jar Sur. 2008;6(1):20-2.