Rupture of the brachial artery accompanying dislocation of the elbow or supracondylar fracture.

Recent experiences w’ith two cases of rupture of the brachial artery, in one of which the rupture was associated with a compound anterior dislocation of the elbow and in the other of which the rupture was associated with a supracondylar fracture, prompted further inquiry into the subject of rupture of the brachial artery in conjunction with these injuries about the elbow, in an attempt to assay the frequency of this complex injury, together with the methods and results of treatment. Rupture of the brachial artery in association with dislocation of the elbow or supracondyiar fracture is rare, judging from the number of such cases reported in the literature. Eliason and Brown collected twenty-one cases, including their own, of arterial injury resulting from dislocation of the elbow. They also found records of reference to two additional cases, but they were unable to obtain the original articles. In sixteen of this group of twenty-one cases, arterial injuries w’ere associated with compound dislocations; and, in fifteen, the brachial artery was the vessel injured. In five, the arterial injury occurred below the bifurcation of the brachial artery; in three it involved the ulnar artery alone; in one, the radial artery alone ; and in one both the radial and the ulnar arteries. In one case, the ruptured vessel proved to be a vein . Because reports of only four of the twentyone cases have been published since the turn of the century, and because only four were in the English language, it is difficult to ascertain the precise details in each case. However, almost all of the dislocations of the elbow were associated with one or more fractures. Whether the brachial artery was severed, lacerated, or contused, in the fifteen cases in which the brachial artery was injured, is not stated. As far as can be determined, only three cases of rupture of the brachial artery have been reported in which the diagnosis has been verified at surgical exploration and dislocation of the elbow without any accompanying fractures has been found. The first, which was reported by Marnham in 1934, was a case of simple posterior dislocation associated with the severance of the brachial artery one-half of an inch (1.27 centimeters) above its bifurcation. Treatment was carried out about one hour after the injury and consisted in surgical exploration of the antecubital space, ligation of the ends of the torn vessel, and reduction of the dislocation. The radial pulse reappeared within three weeks, and the function of the joint was almost normal four months after the injury. The second case was reported by Jackson in 1940. In this instance, the dislocation was simple and anterior. Reduction was accomplished within fifteen minutes of the injury, and, after two hours of medical treatment for progressive vascular insufficiency of both the forearm and hand, the antecubital space was explored surgically. Both ends of the severed brachial artery were found, and active bleeding from the proximal end was observed. A clot in the distal stump was sucked away, after which an end-to-end anastomosis of the artery was performed. A cuff from the brachial vein was utilized to reinforce the anastomosis. Immediately after the operation, the color of the extremity improved, and the radial pulse became palpable. Eight months postoperatively, the patient had a moderate limitation of motion of the elbow, but the blood supply to the forearm and hand appeared to be entirely normal. The third case, mentioned by Mathewson in his discussion of Jackson’s report, was that of rupture of the brachial artery in association with a compound anterior dislocation