Abstract
IntroductionAxillo-subclavian arterial injuries are generally associated with penetrating trauma. On rare occasion, blunt mechanisms can cause these injuries in the setting of high-energy trauma, humeral head or neck fractures, and severe glenohumeral dislocations. Glenohumeral dislocations sustained from ground-level falls are generally reduced in the emergency department without associated morbidity. Presentation of caseAn 80-year-old woman presented with an inferior glenohumeral dislocation after a ground-level fall that was found to be complicated by axillary dissection, pseudoaneurysm, and acute hemorrhage. Endovascular intervention with a balloon-inflatable stent successfully controlled extravasation and restored perfusion to the affected upper extremity. After a short hospitalization, the patient was discharged with intact neurovascular status. DiscussionBlunt axillary artery injury and inferior glenohumeral dislocations are both uncommon entities. A correlation exists between inferior dislocations and neurovascular complications. Accordingly, there may be a role for diagnostic vascular imaging for patients with inferior glenohumeral dislocations. Endovascular stenting was successful in our case and backed by case series and cohort studies in the literature. Some controversy exists regarding stent patency and follow-up planning in trauma patients. ConclusionThis case represents a critical vascular injury from an unexpected mechanism. Inferior glenohumeral dislocations, regardless of injury mechanism, should raise the index of suspicion for vascular involvement. Endovascular repair in our patient was life-saving given her advanced age, acute blood loss anemia, rarity and severity of her injuries and multiple medical comorbidities.
Highlights
Axillo-subclavian arterial injuries are generally associated with penetrating trauma
Inferior glenohumeral dislocations are a rare subtype representing less than 0.5 % of all shoulder dislocations [2]
We present the case of an 80-year-old woman who suffered a traumatic inferior glenohumeral dislocation during a ground-level fall
Summary
Axillo-subclavian arterial injuries are generally associated with penetrating trauma. Glenohumeral dislocations sustained from ground-level falls are generally reduced in the emergency department without associated morbidity. PRESENTATION OF CASE: An 80-year-old woman presented with an inferior glenohumeral dislocation after a ground-level fall that was found to be complicated by axillary dissection, pseudoaneurysm, and acute hemorrhage. There may be a role for diagnostic vascular imaging for patients with inferior glenohumeral dislocations. Some controversy exists regarding stent patency and follow-up planning in trauma patients. Regardless of injury mechanism, should raise the index of suspicion for vascular involvement. Endovascular repair in our patient was life-saving given her advanced age, acute blood loss anemia, rarity and severity of her injuries and multiple medical comorbidities
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