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Proximal humeral fractures with vascular compromise
Philipp Kriechling1,2, Reiss Whitefield1, Navnit S Makaram1,3
1Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
The Bone & Joint Journal
|July 31, 2024
Summary
Vascular compromise is a rare complication of proximal humeral fractures. Identifying specific clinical and radiological signs can aid early diagnosis and improve outcomes with combined surgical intervention.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Trauma Care
Background:
- Proximal humeral fractures can lead to rare but severe vascular compromise.
- Early identification of risk factors is crucial for timely intervention.
Purpose of the Study:
- To determine the incidence of vascular compromise in proximal humeral fractures.
- To identify clinical and radiological predictors of this complication.
- To evaluate a management protocol for these injuries.
Main Methods:
- Retrospective analysis of 3,497 adult patients with proximal humeral fractures over 8 years.
- Comparison of demographic, clinical, and radiological data between patients with and without vascular compromise.
- Univariate analysis to identify predictive factors for vascular compromise.
Main Results:
- An incidence of 0.5% (18 patients) for proximal humeral fractures with vascular compromise was observed.
- Brachial plexus palsy, complete proximal shaft separation with medial displacement, and fracture-dislocation were significant risk factors.
- A protocol involving fracture fixation before vascular intervention yielded favorable outcomes.
Conclusions:
- Specific clinical and radiological 'red flags' can indicate associated vascular injury in proximal humeral fractures.
- Early diagnosis and combined orthopedic and vascular intervention are essential.
- The study protocol demonstrated effective management of these complex injuries.
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