title: Axillary Artery Injury Associated with Proximal Humeral Fractures: Review of Long-Term Vascular, Orthopedic, and Neurologic Outcomes.
abstract: BACKGROUND
  Fracture and dislocation of the proximal humerus is common. It is associated with a number of vascular, neurologic, and orthopedic complications; these include brachial plexopathy and avascular necrosis (AVN) of the humeral head. These complications are rare but can potentially cause severe disability to patients; however, they remain poorly described in the literature. To describe vascular, orthopedic, and neurologic outcomes after axillary artery repair, in patients with proximal humeral fractures or dislocations.
  
  
  METHODS
  We conducted a retrospective review of patients admitted to 2 tertiary trauma centers in Victoria, Australia, with fracture or dislocation of the proximal humerus and associated axillary artery injury. Patients were selected according to guidelines for trauma call or alert and the presence of high-risk mechanism of injury. Data on vascular, orthopedic, and neurologic complications were collected.
  
  
  RESULTS
  Twenty-one patients were identified. Injury to the first part of the axillary artery was noted in 11 patients (52%). Brachial plexus exploration was performed in 17 patients (81%). Four patients (19%) underwent nerve repair. Long-term neurologic recovery was universally poor. Major orthopedic complications included AVN of the humeral head, delayed union, and the need for prosthesis or arthrodesis. Eleven patients (52%) received upper limb fasciotomy. Five patients (24%) underwent delayed secondary upper limb amputation.
  
  
  CONCLUSIONS
  There was an unusually high rate of injuries to the first part of the axillary artery. Close clinical observation is recommended for such patients. AVN of the humeral head and brachial plexopathy remain significant and debilitating complications.
authors.affiliation: Department of Vascular Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia. Electronic address: ajhng.89@gmail.com.
authors.forename: Andrew Jin-Hean
authors.initials: AJ
authors.lastname: Ng
authors.affiliation: Department of Vascular Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Varun
authors.initials: V
authors.lastname: Arora
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Howard Ho-Fung
authors.initials: HH
authors.lastname: Tang
authors.affiliation: Department of Vascular Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Treseder
authors.affiliation: Department of Vascular Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Arvind
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Vascular Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D015901:Angiography, Digital Subtraction; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D001917:Brachial Plexus / Q000503:physiopathology*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000072226:Computed Tomography Angiography; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019637:Orthopedic Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012783:Shoulder Dislocation / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D012784:Shoulder Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D062606:Tertiary Care Centers; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D014739:Victoria; D055815:Young Adult