Humeral artery injury

　　First, etiology

　　In addition to gunshots and bullets, local fracture stab wounds are also common.

　　Second, pathogenesis

　　The humeral artery connects to the axillary artery (below the lower edge of the teres major muscle) and terminates below the elbow crease at 2.5 cm; further downward, it divides into the ulnar artery and radial artery. Its injury rate is high, in addition to gunshot and shrapnel wounds, fractures of the humeral shaft and humeral condyle are common causes of injury in daily life. In the middle segment of the humerus, it is often accompanied by radial nerve and median nerve injuries, and in the upper part of the condyle, the median nerve is mostly affected, with an overall complication rate of up to 60% to 70%.

　　It is often complicated with Volkmann's ischemic contracture: This condition is not common, but once it occurs, it can cause serious consequences. Therefore, it is a serious complication of limb trauma. Symptoms include distal limb ischemic symptoms, such as severe pain, swelling, changes in skin color, weak or inability to move fingers (toes), dullness of sensation, weakened or absent pulse, etc., and whether passive movement of the fingers (toes) causes pain. It should be noted that the above symptoms or signs are manifestations of a later stage.

　　Ischemic contracture of the muscles in the forearm and hand has the basic symptoms of vascular injury, and the following characteristics should be noted for each artery segment:

　　1. Injury to the lower segment of the humeral artery:It is most common in clinical practice, especially in children, and is often seen in fractures of the humeral condyle. It mainly causes ischemic contracture of the muscles in the forearm and hand, known as Volkmann's ischemic contracture, which may lead to disabilities.

　　2, Humeral artery middle segment injury:In addition to being more common in humeral shaft fractures, inserting catheters through the humeral artery and percutaneous puncture can also cause secondary thrombosis formation, leading to the same consequences in the forearm and hand; in this case, the median nerve is also prone to dysfunction.

　　3, Humeral artery upper segment injury:Less common than the former two, due to the rich collateral vessels of the shoulder joint vascular network, once blocked, its impact on the blood supply of the limb is lighter than the former two.

　　According to the aforementioned diagnostic criteria, the diagnosis of humeral artery injury is generally not difficult, the key is to make an early diagnosis, especially for those with humeral condyle fracture combined with vascular injury, or those with suspected injury in the middle segment of the humeral artery. Once the humeral artery is completely blocked, due to insufficient blood supply of the vascular network of the elbow joint, it is impossible to escape the ischemic necrosis of the muscle group beyond the forearm, which can lead to permanent disability. In order to avoid this serious consequence, various examination methods should be used, including surgical exploration, etc., so as to avoid this serious consequence.

　　This disease is caused by direct trauma to the humerus, such as kicking, falling, or violent fighting, etc., which directly causes injury. Therefore, attention should be paid to living habits, high-risk workers such as construction workers and miners are prone to injury, and protection should be paid attention to during the work process. Be calm when facing things, avoid emotional excitement and conflict leading to this disease. Secondly, early discovery, early diagnosis, and early treatment are also of great significance for the prevention of this disease.

　　Humeral artery injury is usually caused by humeral fracture, and the diagnosis of humeral neck fracture is easy. There must also be a lateral film (through the chest position) to understand whether the humeral head has rotation, impaction, or anterior and posterior overlap displacement deformity, so as to clarify whether the fracture end has an angular deformity forward. Since it is easy to cause injury to blood vessels and nerves during the consolidation of fractures, attention should also be paid to compartment syndrome. For those with obvious swelling in the affected limb after injury, X-ray examination can be performed, and blood pressure and blood routine examination can be conducted at the same time to clarify whether there is progressive hemorrhage.

　　1, 150 grams of cow bone marrow. Toast 500 grams of flour, dry and grind the eggshell powder, toast 250 grams of black sesame seeds, grind 250 grams of sugar into fine powder, mix them together. Take 2 spoons each day, dissolve in boiling water and eat. It is used for those with kidney deficiency and aversion to cold in the limbs.

　　2, Astragalus 20 grams, 5 red dates, boil the soup as tea, or take the juice to cook rice or porridge. It is used for those with a constitutionally weak body and delayed healing of fractures. If prone to catching cold, add 5 grams of forsythia, and boil the soup as tea.

　　3, Chestnuts 300 grams (shell removed and meat taken out), a young grass chicken (killed, cleaned and cut into pieces), add soy sauce, wine, and sugar, simmer until the chicken is tender and the chestnuts are soft, and eat it in several servings as a side dish. It is used for those with deficiency of both the spleen and kidney.

　　4, Dog meat 500 grams (soaked, pounded and washed until clean, drained), grass chicken 300 grams, pork shank 150 grams, add water, simmer until the chicken and pork shank are tender, add 15 grams of goji berries, 10 grams of dried tangerine peel, 10 grams of prepared rehmannia, 3 grams of licorice, and steam until the dog meat is soft and tender, season with taste, and eat in moderation. It is used for those with aversion to cold, lack of strength, weakness of the waist and knees, and deficiency of the body and insufficient food intake.

　　I. Treatment

　　1. Immediately eliminate the cause of injury for displaced supracondylar fractures of the humerus or other fractures, usually by manual reduction combined with Kirschner wire bone traction surgery, and compare the changes in radial artery pulsation before and after the operation.

　　2. Prepare well for preoperative procedures due to the serious consequences of humeral artery injury, time is the primary condition for obtaining the best efficacy. On this premise, the clinical physician should take various effective measures while preparing for surgical exploration and treatment to minimize complications.

　　3. The operation should maintain blood flow due to the importance of the humeral artery to distal blood supply, the operation must be thorough, and for damaged vessels, especially those with involved intima or elastic layer, a lenient attitude should not be adopted. When it is necessary to transplant the great saphenous vein or other vessels, it should be done promptly, and attention should be paid to the vascular anastomosis technique to strive for perfection to ensure the patency of the vessel.

　　4. Take into account the treatment of the fracture due to the majority of the causes of humeral artery injury being due to corresponding segmental humeral fractures, therefore, in order to avoid a second injury, the local fracture should be treated at the same time. Generally, open reduction and internal fixation is the preferred treatment method.

　　5. Pay attention to postoperative management due to the complex anatomical relationship of this area, especially the position of the elbow joint and the selection of upper limb fixation methods. Therefore, after the brachial artery recovers blood flow, it is necessary to pay attention to the observation of vascular patency, and more attention should be paid to avoiding various factors that may affect vascular patency in postoperative management, especially the displacement after reduction of the supracondylar fracture of the humerus, which is a common cause of re-injury to the brachial artery.

　　II. Prognosis

　　After treatment, the prognosis is good for those with patent brachial artery. If the brachial artery is obstructed or ligated, or if ischemic changes have appeared in the distal limb muscles, it can cause Volkmann's ischemic contracture and present with permanent disability of the affected limb.