Navigating the diagnostic pitfall of concealed brachial artery disconnection masquerading as simple elbow dislocation

Background Although neurovascular injuries are known complications of elbow dislocations, they typically present with obvious signs of ischemia. However, it is extremely rare for a complete arterial disconnection to masquerade as a simple dislocation. This specific type of occult injury often presents with a deceptive clinical picture, making it highly susceptible to missed diagnoses. Case presentation We report a case of complete brachial artery disconnection that masqueraded as a simple posterior elbow dislocation. Despite the distal extremity appearing well-perfused upon admission (a deceptive presentation), the patient developed delayed vascular crisis several hours post-reduction. The limb was successfully salvaged after a two-stage revascularization procedure involving vein grafting. Conclusion Clinicians must remain vigilant for this diagnostic pitfall. Vascular injuries cannot be ruled out based solely on initial physical examination signs. Establishing a dynamic monitoring protocol is essential to prevent missed diagnoses in such cases.