Abstract
Background Proximal humerus fractures account for 4 – 6% of all fractures and are a common result
of low-energy trauma in the elderly. Concomitant neurovascular injury of the neighboring
axillary artery and brachial plexus is a rarity, but has enormous impact on therapy,
rehabilitation and prognosis. Diagnosis of axillary artery injury may be delayed due
to its varied clinical presentation and lead to prolonged ischemia, distal necrosis
and even loss of limb. Thorough clinical examination, high suspicion and identification
of known predictors can be helpful in early diagnosis of this rare injury.
Patients/Material and Methods We report a case of an intoxicated 76-year-old male who sustained a dislocated proximal
humerus fracture, resulting in concomitant brachial plexopathy and axillary artery
dissection with secondary thrombosis after a low-energy fall from standing height.
Due to mistriage as a neurological emergency the somnolent patient presented under
delayed circumstances at our traumatological emergency department, demonstrating pain,
paleness, paralysis, paresthesia and non-palpable wrist pulses. Diagnosis was made
through high suspicion after clinical examination with the aid of CT angiography.
Emergent open reduction and anatomic shoulder hemiarthroplasty was performed followed
by axillobrachial interposition grafting using a reversed saphenous vein graft and
brachial plexus exploration.
Results The surgical treatments were uncomplicated. The affected limb remains viable at 6-week
follow-up; however, active shoulder function is limited due to residual brachial plexopathy.
Conclusion Despite early diagnosis and management of this rare injury, the prognosis for functional
recovery is guarded and largely dictated by the extent of neurological injury in the
setting of concomitant brachial plexopathy. Brachial plexopathy is highly associated
with axillary artery injury and its impact often underestimated in comparison due
to its non-limb-threatening nature in the acute setting. Future studies should focus
on the long-term prognosis for functional recovery in patients with this rare injury
pattern.
Key words
proximal humerus fracture - axillary artery - brachial plexus - dissection - thrombosis
