A Rare Case of Humeral Head Fracture Dislocation with Vascular Injury: How we Managed it-current Concepts

Proximal humerus fractures (PHFs) account for 5 to 6 percent of all adult fractures and often occur in elderly individuals who experience low-energy falls. The healthcare burden associated with these fractures is significant and involved both the direct and indirect costs associated with osteoporosis and fragility fractures. Increased efforts are being made to detect and manage these fractures. Additionally, as the general population continues to age and an increasing percentage of patients are noted to have low bone density, the nonoperative and operative management strategies for proximal humerus fractures continue to receive considerable attention in the literature. Despite the prevalence of proximal humerus fractures, axillary artery damage is rare. In the literature, anterior glenohumeral dislocation has been associated to the majority of axillary artery injuries; a few have also been connected to single proximal humerus fractures or fracture-dislocation. Due to its anatomical location, the axillary artery is susceptible to damage from a proximal humerus fracture. Even though the radial pulse may be felt, there is enough collateral circulation in the upper limbs for vascular injury to happen. The most common vascular injury produced by a proximal humerus fracture was an intimal rupture with subsequent thrombosis, and the peripheral pulses were feeble and no ischemia, axillary artery injury often goes undiagnosed at first, putting the hand at risk of necrosis and amputation if ischemia persists, and the forearm at risk of compartment syndrome after revascularization. A comprehensive physical examination, as well as a low threshold for Doppler tests or angiography, can be used to diagnose axillary artery injury. Despite the fact that the vascular insult resolves spontaneously, it is vital to recognize the link between such fractures and vascular injuries in order to diagnose them early and avoid major complications such as amputation. We provide a case of axillary artery injury associated with proximal humerus fractures to demonstrate the risk of axillary artery injury in the setting of proximal humerus fractures.