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What major artery must be examined for injury following a clavicular fracture?
{{c1::Subclavian artery}}
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“Image licensed by Physeo and used with permission. Purchase full access here.”; Photo credit: English: Nicholas Zaorsky, M.D., CC BY-SA 3.0, via Wikimedia Commons
What additional vascular imaging study is recommended if this noninvasive imaging is abnormal?
Additional vascular imaging is advised if the ABI is less than 0.9. Formal contrast angiography (FCA), CTA, and duplex ultrasonography are available options (see table below). CTA is currently the preferred test (of choice) due to its accessibility, speed, and noninvasiveness. Formal contrast arteriography is invasive (needs direct femoral artery puncture) and delays management by necessitating the referralto an interventional radiology team.
- Especially if there's a bruit → CT angiography
- May also damage the brachial plexus
- Middle fractures → conservative treatment
- Distal fractures / unstable fracture → ORIF
“Image licensed by Physeo and used with permission. Purchase full access here.”; Photo credit: English: Nicholas Zaorsky, M.D., CC BY-SA 3.0, via Wikimedia Commons
What additional vascular imaging study is recommended if this noninvasive imaging is abnormal?
Additional vascular imaging is advised if the ABI is less than 0.9. Formal contrast angiography (FCA), CTA, and duplex ultrasonography are available options (see table below). CTA is currently the preferred test (of choice) due to its accessibility, speed, and noninvasiveness. Formal contrast arteriography is invasive (needs direct femoral artery puncture) and delays management by necessitating the referralto an interventional radiology team.
| Study | Pros | Cons |
|---|---|---|
| CTA | Quick, accessible, and non-invasive | Small/distal arteries are difficult to visualise; an intravenous contrast agent injection is used. |
| Duplex US | Precise, non-invasive | Operator-reliant; not easily accessible |
| Contrast arteriography | Highly sensitive and specific | Costly, time-consuming, and invasive; involves intra-arterial contrast media |
| Injury | Artery affected | Characteristics |
|---|---|---|
| Dislocations of the shoulder girdle | Axillary artery | Seizures can cause posterior dislocations, which are more likely to injure the axillary nerve. Axillary artery damage commonly accompany anterior dislocations which are more common |
| Clavicle fracture | Subclavian artery | Patients may also have hemothorax or pneumothorax. |
| Supracondylar fracture | Brachial artery | More frequently affects children and, if ignored, can lead to Volkmann's contracture |
| Pelvic fracture | Branches of internal iliac artery (superior gluteal and internal pudendal) | The superior gluteal artery is more likely to be the source of arterial bleeding when there are severe posterior fractures. Injury to the internal pudendal artery can arise from severe anterior fractures, which is a major source of blood loss. Both injuries can cause major blood loss and hemorrhagic shock |
| Hip dislocation | Femoral artery | Posterior dislocations manifest as an internally rotated and adducted leg with an increased incidence of sciatic nerve injury. Anterior dislocations present with externally rotated and abducted legs with an increased risk of femoral artery injury. Also, risk of avascular necrosis if combined with femoral head fracture |
| Knee dislocation | Popliteal artery | Patients with posterior dislocation experience arterial injury more commonly than those with anterior dislocation. |
| Tibial plateau fracture | Popliteal artery | Patients with medial injuries get arterial damage more commonly than those with lateral injuries. |
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