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Case Reports
. 2021 Oct 25:36:100547.
doi: 10.1016/j.tcr.2021.100547. eCollection 2021 Dec.

Two stage treatment of a proximal humeral fracture-dislocation with vascular injury: Case report of a multidisciplinary approach

Lorenzo Maria Di Giacomo  1 , Fabrizio Marzano  1 , Andrea Zaganelli  1 , Valerio Pace  1 , Rosario Petruccelli  1 , Giuseppe Rinonapoli  1 , Auro Caraffa  1
Affiliations
Case Reports

Two stage treatment of a proximal humeral fracture-dislocation with vascular injury: Case report of a multidisciplinary approach

Lorenzo Maria Di Giacomo et al. Trauma Case Rep. .

Erratum in

Abstract

Proximal humeral fracture-dislocation associated with neurovascular injury is rare events, associated with poorer outcomes and higher risk of complications. A multidisciplinary approach including the orthopaedic and vascular department is essential in treating such kind of injury. The goal of the treatment is to restore the vascular supply and stabilize the fracture. Usually the orthopaedic surgical stabilization provides a stable substrate for the vascular repair. We report a case of 70 years old woman who sustained a 4 part proximal humerus fracture-dislocation with vascular injury at the level of the transition of the subclavian into axillary artery. Because of the impending severe limb ischemia, the priority of the treatment was given to vascular surgical intervention with a by-pass procedure. After 14 days a reverse shoulder prosthesis was thought to be the best alternative in the second stage surgery. At 18 months follow-up we achieved good clinical and radiological outcomes. Although a lack of consensus on the priority of treatments, we achieved good result following our proposed algorithm of treatment.

Keywords: Brachial plexus injury; Fracture-dislocation; Multidisciplinary approach; Proximal humeral fracture; Vascular injury.

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Conflict of interest statement

All authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.

Figures

Fig. 1
Fig. 1
Plain X-ray at the admission.
Fig. 2
Fig. 2
X-ray after attempt to reduction.
Fig. 3
Fig. 3
Angiography showing occlusion between subclavian and axillary artery.
Fig. 4
Fig. 4
Range of motion at 18 follow-up.
Fig. 5
Fig. 5
Postoperative X Ray of the shoulder at 6 month follow-up.
See this image and copyright information in PMC

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