Delayed presentation of brachial artery injury following fracture shaft humerus; whether amputate or salvage: A series of two cases

Abstract

Vascular injury is a complication after humerus fracture that has been associated with shoulder dislocation, fracture proximal, and supracondylar region of the humerus. Combined vascular and bony injuries are diagnosed and referred earlier than 24 h. However, delayed presentation of brachial artery injury after shaft humerus fracture beyond the golden period of 6 h has been little reported. In this series, we aimed at evaluating the likelihood of limb salvage. Case 1, was 24 years old with open fracture that presented after 18 h, managed with fasciotomy with arteriotomy with thrombectomy followed by temporary skeletal stabilization and definitive thereafter. Case 2, was 39 year old with closed fracture, presented after 76 h with digital gangrene in which definitive fracture fixation was first done followed by transbrachial thrombectomy with amputation of digits. Our results were good with minimal morbidity due to joint stiffness, restriction of range of motion, and complications of ischemia.