Vascular Injury Accompanying Displaced Proximal Humeral Fractures: Two Cases and a Review of the Literature

We present two cases in which displaced proximal humeral fractures are accompanied by vascular injury. These Injuries are very rare but severe and the accompanying vascular impairment can have great clinical consequences. Therefore, we try to emphasize on the importance of thorough and accurate diagnostics, because it is obligatory for early diagnosis and improving the eventual outcome of these injuries. The specific order in treatment (internal fixation first or vascular repair first) depends on the severity of the accompanying vascular injury. The increasing use of endovascular procedures to treat vascular lesions is a very interesting development with several advantages, especially in elderly and multimorbid patients. 1. Introduction Peripheral neurological injury in association with displaced fractures of the proximal humerus is not unusual. However, major vascular injury in association with these fractures is uncommon [1, 2]. Extremity fractures are accompanied by arterial lesions in 0.9%. Certain skeletal injuries, such as supracondylar humeral fractures, elbow joint dislocation fractures, supracondylar femoral fractures, and posterior knee joint dislocations, are far more often accompanied by vascular lesions, with a frequency of up to 10%. Finally, all fractures involving long bones are at higher risk for vascular injuries [3]. Because of the rarity of vascular lesions associated with proximal humeral fractures, accompanying arterial lesions can be easily overlooked, especially in fractures not readily associated with arterial injury. Nevertheless, the possibility of axillary arterial injury should be considered in every fracture of the proximal humerus with severe medial displacement of the shaft [1]. In this paper, we present two cases of closed proximal humeral fractures with accompanying vascular lesions due to fracture displacement and describe the treatment options. This paper was motivated in the first place by the rareness and severity of vascular complications accompanying a proximal humeral fracture. In second place by the fact that there is a considerable variation in clinical symptoms of these fractures. Furthermore, we wanted to show that endovascular procedures are valuable alternatives to open procedures with a minimum of additional trauma. 2. Case Report I A 92-year-old woman was referred to the emergency room after she was found at home lying for approximately 2.5 hours at the floor after a fall on her left shoulder. The patient complained of pain in her left upper arm and of hypoesthesia of her left forearm distally to the