Iatrogenic injury of the axillary artery as a complication of a bony Bankart repair following traumatic anterior shoulder dislocation—a case report

The state-of-the-art treatment for glenoid fractures is arthroscopic reconstruction. Depending on the fracture configuration, a 5:30 o’clock portal may be necessary. Injury to proximal neurovascular structures is a rare but devastating complication.

A 63-year-old woman suffered a shoulder dislocation with an anterior glenoid fracture and rotator cuff tear from a fall. Arthroscopic refixation of the bony Bankart lesion was performed using a 5:30 o’clock portal. The immediate postoperative course was without pathological findings. After 3 days she developed severe shoulder pain and paleness of the extremity. Contrast-enhanced computed tomography showed a false aneurysm of the axillary artery. Surgical vascular reconstruction was performed immediately. After a prolonged rehabilitation process, she reported no residual pain and a good range of motion. The age-adjusted Constant score was 89, and the score of the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire was 25.8.

A lesion of the axillary artery is a severe complication that can lead to ischemia and loss of the extremity. Blunt dissection of the portal and the use of cannulas may help to prevent this complication. Increasing pain, swelling, and sensorimotor abnormalities should prompt an immediate diagnostic workup.