Journal of Orthopedics and Joint Surgery

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VOLUME 4 , ISSUE 2 ( July-December, 2022 ) > List of Articles


A Case of Humeral Head Fracture-dislocation with Vascular Injury: How We Managed it

K Meenakshisundaram, Nagesh C Sangolgi, KG Kandaswamy, Hari Sivanandan, Athipathi Sundararaj, KP Chiranjeevi

Keywords : Axillary artery injury, Humeral head fracture-dislocation, Proximal humerus fracture dislocation, Vascular injury

Citation Information : Meenakshisundaram K, Sangolgi NC, Kandaswamy K, Sivanandan H, Sundararaj A, Chiranjeevi K. A Case of Humeral Head Fracture-dislocation with Vascular Injury: How We Managed it. 2022; 4 (2):91-93.

DOI: 10.5005/jp-journals-10079-1100

License: CC BY-NC 4.0

Published Online: 31-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Axillary artery injury is uncommon, although proximal humerus fractures are prevalent. The majority of axillary artery injuries in the literature have been attributed to anterior glenohumeral dislocation; a few have been linked to single proximal humerus fractures or fracture-dislocation. The axillary artery is vulnerable to injury because of a proximal humerus fracture due to its anatomical placement. Due to the quantity of collateral circulation in the upper limbs, vascular damage may occur even though the radial pulse is perceptible. The most common vascular injury produced by a proximal humerus fracture was an intimal rupture with subsequent thrombosis because there are no palpable peripheral pulses 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 diagnose axillary artery injury. Although 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 show the risk of axillary artery injury in the setting of proximal humerus fractures.

  1. Hayes JM, Van Winkle GN. Axillary artery injury with minimally displaced fracture of the neck of the humerus. J Trauma 1983;23(5):431–433. DOI: 10.1097/00005373-198305000-00014
  2. Sukeik M, Vashista G, Shaath N. Axillary artery compromise in a minimally displaced proximal humerus fracture: a case report. Cases J 2009;2:9308. DOI: 10.1186/1757-1626-2-9308
  3. Peters RM, Menendez ME, Mellema JJ, et al. Axillary artery injury associated with proximal humerus fracture: a report of 6 cases. Arch Bone Jt Surg 2017;5(1):52–57.
  4. Thorsness R, English C, Gross J, et al. Proximal humerus fractures with associated axillary artery injury. J Orthop Trauma 2014;28(11):659–663. DOI: 10.1097/BOT.0000000000000114
  5. Yagubyan M, Panneton JM. Axillary artery injury from humeral neck fracture: a rare but disabling traumatic event. Vasc Endovascular Surg 2004;38(2):175–184. DOI: 10.1177/153857440403800210
  6. Theodorides T, de Keizer C. Injuries of the axillary artery caused by fractures of the neck of the humerus. Injury 1976;8(2):120–123. DOI: 10.1016/0020-1383(76)90045-0
  7. Zuckerman JD, Flugstad DL, Teitz CC, et al. Axillary artery injury as a complication of proximal humeral fractures. Two case reports and a review of the literature. Clin Orthop Relat Res 1984;189:234–237.
  8. Kelley SP, Hinsche AF, Hossain JF. Axillary artery transection following anterior shoulder dislocation: classical presentation and current concepts. Injury 2004;35(11):1128–1132. DOI: 10.1016/j.injury.2003.08.009
  9. Jensen BV, Jacobsen J, Andreasen H. Late appearance of arterial injury caused by fracture of the neck of the humerus. J Trauma 1987;27(12):1368–1369. DOI: 10.1097/00005373-198712000-00010
  10. Menendez ME, Ring D, Heng M. Proximal humerus fracture with injury to the axillary artery: a population-based study. Injury 2015;46(7):1367–1371. DOI: 10.1016/j.injury.2015.04.026
  11. Neuhaus V, Bot AG, Swellengrebel CH, et al. Treatment choice affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus. J Shoulder Elbow Surg 2014;23(6):800–806. DOI: 10.1016/j.jse.2013.09.006
  12. Palanisamy JV, Vaithilingam A, Arkesh M, et al. Proximal humerus fracture dislocation leading to axillary artery injury in an young adult: case report of an unusual presentation. J Clin Orthop Trauma 2017;8(Suppl 1):S62–S66. DOI: 10.1016/j.jcot.2017.05.006
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