Iatrogenic Brachial Artery Injury During Long Proximal Humeral Interlocking System (PHILOS) Plating

Iatrogenic vascular injuries are rare but potentially serious complications that can occur during orthopedic procedures involving the proximal humerus. We present a case report of a patient who sustained a brachial artery injury during a long Proximal Humeral Interlocking System (PHILOS) plating procedure for a proximal humeral fracture. A 62-year-old female patient with a left humerus proximal 1/3 shaft fracture underwent open reduction and internal fixation with a long PHILOS plate. During the procedure, difficulty was encountered in achieving adequate plate positioning due to osteoporotic bone and fracture comminution. Upon insertion of a distal second last screw, brisk brachial artery bleeding was encountered. Immediate hemostasis measures were taken, and a plastic surgeon was consulted. The brachial artery injury was identified and repaired with a cephalic vein graft harvested and flushed. Postoperatively, the patient developed median nerve neuropraxia. This case highlights the risk of iatrogenic brachial artery injury during left humerus proximal 1/3 shaft fracture fixation, especially in cases with technical challenges due to osteoporotic bone or comminution. Prompt recognition, involvement of vascular surgery, and appropriate management are crucial in mitigating potential devastating consequences. Associated neurological complications, such as nerve injuries, can also occur and should be monitored. Meticulous surgical technique, anatomical awareness, and vigilant monitoring are essential to minimize the risk of vascular and neurological complications during these procedures. Iatrogenic brachial artery injury is a rare but potentially serious complication of humerus proximal 1/3 shaft fracture. Early recognition, multidisciplinary involvement, and appropriate management strategies are crucial in optimizing patient outcomes and preventing long-term morbidity.