ELSEVIER PII: SOO20-1383(98)00060-6 hjury Vol. 29, No. 5, pp. 390-392, 1998 0 1998 Elsevier Science Ltd. All rights reserved Printed in Great Britain 0020.1383/98 $19.00+0.00 Delayed diagnosis of a ruptured brachial artery after posterior dislocation of the elbow H. Eijer’, F. T. Ballmerl, H. B. Ris’ and R. Hertel’ Departments of ‘Orthopaedic Surgery and 2Vascular Surgery, University Hospital, Inselspital, 3010 Berne, Switzerland Injury, Vol. 29, No. 5, 390-392, 1998 Introduction Traumatic rupture of the brachial artery is a known complication following posterior dislocation of the elbow. It is mainly found in young adults and in children’“. Both intimal lesions and complete ruptures of the artery have been reported. Review articles describe this complication to be rare and serious’,-‘. Even after appropriate operative treatment of the arterial lesion and the dislocation, important sequelae have been reported”. We describe a patient who sustained a posterior dislocation of the elbow associated with a complete rupture of the brachial artery. Interposition of a long saphenous vein graft followed by reconstruction of the medial collateral ligament of the elbow resulted in a satisfactory outcome despite a delay in diagnosis of more than 24 h. Case report An 18year-old right-handed student fell onto his left elbow while snowboarding. He described a popping sensation in his elbow during the impact. Clinical and radiographic examination in a local casualty department revealed normal alignment of the elbow without bony lesions. The next day the arm was so swollen that he presented to another casualty department from where he was referred to us. On admission the patient complained of numbness in the thumb and the index finger. Clinically a gross swelling of the elbow and decreasedskin temperature of the forearm were noted. Elbow motion was reduced owing to pain and swelling. A strong radial pulse was palpable. Two-point discrimination was reduced on the thumb and the index finger. There was no weaknessin the muscles innervated by the ulnar, radial or median nerve. Repeated conventional X-rays of the elbow made in our institution showed no dislocation or subluxation (Figure 1). Angio- graphy revealed an occlusion of the brachial artery 3 cm proximal to the elbow joint (Figure 2). A dislocation-related rupture of the brachial artery was therefore suspected. At operation on the same day a complete rupture of the artery was confirmed. Blood flow to the forearm was (4 (b) Figure 3. Conventional AP (a) and lateral (b) X-rays taken more than 24h after the initial injury. No dislocation or bony lesions can be seen.