Shoulder fracture-dislocation with arterial dissection

Case contributed by Dr Henry Knipe

Presentation

Fall with shoulder pain. No radial pulse.

Patient Data

Age: 80 years
Gender: Female
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 lipohaemarthrosis. 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 calibre 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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Case information

rID: 53653
Case created: 29th May 2017
Last edited: 22nd Jun 2017
Inclusion in quiz mode: Included

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