Reverse total shoulder replacement after traumatic acute ischemia of the upper limb due to proximal humerus fracture

Proximal humerus fractures represent approximately 5% of all fractures, predominantly affecting elderly patients with osteoporotic bone. While many cases are minimally displaced and treated conservatively, complex fracture patterns-particularly those involving multiple fragments or head-splitting components-pose significant diagnostic and therapeutic challenges. One of the rare but serious complications of these injuries is vascular involvement, most notably affecting the axillary artery due to its anatomical proximity. Although uncommon, acute ischemia of the upper limb secondary to such trauma requires prompt diagnosis and urgent multidisciplinary management to avoid irreversible tissue damage or limb loss. We report the case of a 58-year-old man who presented with a complex four-part proximal humerus fracture with a head-split configuration following a fall from standing height. The trauma was complicated by acute limb ischemia caused by blunt injury to the axillary artery.