Flail upper limb due to delayed presentation of a traumatic brachial artery pseudoaneurysm

An 81-year-old woman presented with a right mid-shaft closed humerus fracture (dominant limb) following a mechanical fall. Her medical history included type 2 diabetes, hypertension, asthma and hypothyroidism. The patient was fully independent in all activities of daily living. Humeral fracture was managed conservatively, and the patient was discharged with a routine fracture clinic follow-up. Unfortunately, two consecutive follow-up appointments were missed by the patient and the first review after a fall was done with a delay of 9 months. During an outpatient visit, the patient complained of a chronic swelling, pain and general lack of function in the upper limb. Routine plain x-ray showed a chronic non-union of the humerus (figure 1). Examination revealed a swollen right upper limb and a mid-arm pulsatile mass with a systolic bruit on auscultation (figure 2). There was no evidence of vascular deficit. However, there was an obvious wrist drop with the reduced sensation in the radial nerve distribution and severely reduced range of all movements (figure 2). Clinical diagnosis of a flail upper limb secondary to brachial artery (BRA) pseudoaneurysm was made. This was confirmed by CT …