Brachial artery pseudoaneurysm after fixation of supracondylar fracture in a 9-year-old child.

Abstract

The supracondylar humerus fracture is the most common elbow fracture in children, corresponding to 58% of these cases. The objective of this study is to report a rare postoperative complication, the pseudoaneurysm of the brachial artery. A 9-year-old girl with was admitted with a Gartland III supracondylar fracture of the right humerus, presenting normal neurological and vascular exams. The patient underwent a surgical treatment with percutaneous fixation and immobilization and was re-evaluated after 2 and 4 weeks. In the last evaluation the immobilization and fixation were removed. She returned after 3 months, presenting a progressive palpable, painless mass in the 1/3 distal right arm. The arterial ultrasound showed a mass in the cubital fossa, which presented internal flow and some wall thrombi, compatible with pseudoaneurysm of the brachial artery. After diagnosis, the treatment was a vascular surgery for dissection and reconstruction of the artery. The incidence of vascular involvement in Gartland III fractures ranges from 2% to 38%. False aneurysms originate from arterial hematomas caused by trauma to the arterial lumen, and their developing time can vary. There are few reports of this complication, so there is no consensus about the treatment.