Presentation
Fall with shoulder pain. No radial pulse.
Patient Data
Humeral head is anteriorly dislocated with severe (complete) posterior displacement of the surgical neck of humerus fracture. Comminuted greater tuberosity fracture again noted.
Complex, heavily comminuted proximal humerus fracture-dislocation. Off-ended surgical neck of humerus fracture with complete anterior displacement of the humeral head, which is dislocated from the glenoid anteriorly. Avulsion fracture of the greater tuberosity. Glenohumeral lipohemarthrosis. Surrounding fat stranding.
Non-opacified axillary artery for a length of approximately 3 cm as it passes inferiorly to the fracture humeral head. Proximally there is some wall irregularity. Distally there is opacification via collaterals but the brachial artery is small caliber with patchy opacification.
Case Discussion
Vascular injury in the setting of proximal humerus fractures and fracture-dislocation is considered rare. Various mechanisms have been raised including direct penetrating injury from intimal injury and dissection, bone fragments, or rupture/avulsion.
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