Axillary artery and brachial plexus injury secondary to proximal humeral fractures: A report of 2 cases

Highlights • Axillary artery and brachial plexus injury secondary to proximal humeral fracture is rare but can lead to be severe sequels. • The anatomical position of the axillary artery makes it susceptible to injury secondary to proximal humeral fracture. • The upper limbs are rich in collateral circulation and vascular damage cannot be ruled out even if the radial pulse is palpable. • The most common vascular injury secondary to proximal humeral fracture was an intimal tear with secondary thrombosis. • The dislocated humeral head fracture suggested that the nerve injury in both patients was primarily caused by a mechanical factor.
Introduction Axillary artery and brachial plexus injuries have been reported to be associated with proximal humeral fractures. In this report, we present two cases of axillary artery and brachial plexus injury secondary to proximal humeral fracture. Presentation of cases Case 1: An 88-year-old woman with cognitive impairment slipped and fell at home. The diagnosis was left proximal humeral fracture. The second day, paralysis of left upper arm due to left axillary artery occlusion appeared. Axillary-brachial artery bypass surgery was performed. After that, a radial artery pulse was palpable. Ten months have passed since the operation, but the neurologic deficit has not been restored. Case 2: A 74-year-old woman fell from a ladder. She was diagnosed with a right proximal humeral fracture and right axillary artery occlusion. Emergency axillary-brachial bypass surgery and osteosynthesis were performed. After reestablishing the blood flow, there have been no signs of blood flow disorders but paralysis has remained. Discussion In neither of the two cases, were obvious findings of brachial plexus injury detected during surgery. The delayed onset of motor palsy implied that an ischemic factor was implicated in case 1. The acute onset of motor palsy might have been caused by a mechanical factor such as the dislocated of humeral head in case 2. Conclusion Axillary artery and brachial plexus injury secondary to proximal humeral fracture is rare but it can develop severe sequels. By identifying the high-risk patients, diagnosis and management of this vascular and plexus injury might lead to improvement.