Acute deep venous thrombosis and late onset axillary artery injury after a displaced, proximal humerus fracture-dislocat
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CASE REPORT
Acute deep venous thrombosis and late onset axillary artery injury after a displaced, proximal humerus fracture‑dislocation in an octogenarian patient Carlo Biz1 · Giacomo Maso1 · Stefano Citterio1 · Claudio Iacobellis1 · Pietro Ruggieri1 Received: 22 April 2019 / Accepted: 18 July 2019 © Springer Nature Switzerland AG 2019
Keywords Axillary artery injury · Elderly patient · Proximal humerus fracture · Axillo-humeral bypass · Total reverse shoulder arthroplasty
Introduction Proximal humeral fractures are among the most common fractures in elderly population and they account for around 5% of all fractures seen and treated in an emergency department (ED) [1]. These lesions can be associated with severe neurological or vascular injuries [1, 2]. Nevertheless, axillary artery injury is often unrecognized at the patient’s initial presentation, placing the hand at risk of necrosis and amputation if there is prolonged ischemia [3]. This vascular lesion is typically the result of the medial displacement of the proximal humeral shaft in high-energy injuries around the shoulder girdle [2]. Further, deep venous thrombosis (DVT) is another extremely rare condition in fractures of the upper extremities, regarding which the need for thromboprophylaxis before and after surgery is still a matter of debate. A DVT of the upper limb is defined as a thrombus in any of the deep veins of the upper limb which can be classified as primary (i.e. due to vein compression) or secondary (i.e. due to coagulopathy or surgery) and can cause severe consequences, such as pulmonary embolism. This report describes the unusual case of an octogenarian patient with a displaced proximal humeral fracture-dislocation, complicated by a severe pulmonary embolism due to axillary vein thrombosis at the time of presentation, which delayed the orthopaedic surgical treatment by 8 weeks. Subsequently, the inveterate fracture was treated by a reverse * Carlo Biz [email protected] 1
Orthopaedic, Traumatological and Oncological Clinic, Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
total shoulder arthroplasty (RTSA), previous vascular bypass of the axillary artery, because of its intraoperative injury.
Case presentation An 81-year-old right-handed woman was admitted to the ED of our institution, presenting severe pain in the right shoulder and extremely decreased movement of her entire right upper limb. A few hours previously, she had accidentally fallen on the sidewalk. Her medical history was significant for chronic kidney disease, hypertension and hypercholesterolemia, for which she was taking adequate therapy. She did not drink or smoke and she did not report a specific history of previous trauma. Physical examination revealed functional impotence of her right upper limb, swelling, ecchymosis and hematoma on the lateral side of the shoulder and pain at the slightest attempted motion. At initial assessment, the radial pulse was valid, and no neurologic deficits were d
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