Life-Threatening Hemorrhage from an Unrecognized Axillary Vein Injury During Treatment of a Proximal Humeral Fracture-Dislocation with a Known Axillary Artery Injury: A Case Report.

CASE: A 57-year-old man presented with bilateral proximal humeral fracture-dislocation and an associated axillary artery injury. He was treated urgently with reduction, arterial repair, fasciotomies, and skeletal stabilization. The patient sustained a massive intraoperative hemorrhage from an unrecognized axillary vein injury after the arterial repair.

CONCLUSION

An unrecognized axillary vein injury led to substantial blood loss that required a massive transfusion protocol. Although an axillary arterial injury is readily identified with computed tomography angiography, concomitant venous injuries may go unrecognized. The surgical team, including the vascular and orthopaedic surgeons and the anesthesiologists, should be prepared to manage a life-threatening hemorrhage.