Polytrauma With an Open Three-Part Proximal Humeral Fracture and Ipsilateral Comminuted Olecranon Fracture in an Intoxicated Patient: Challenges in Management

We report the case of a young male polytrauma patient who sustained an open three-part proximal humeral fracture with an associated ipsilateral comminuted olecranon fracture following a fall from height. On presentation, he was intoxicated and hemodynamically unstable, requiring immediate management according to Advanced Trauma Life Support principles. Initial management included prompt resuscitation followed by urgent irrigation and debridement of the open fracture. Definitive fixation was performed in a staged manner after physiological optimization. The proximal humeral fracture was managed with dual plating and calcar support to restore stability and alignment, while the comminuted olecranon fracture required a multimodal fixation approach incorporating plates, cerclage wiring, and screw fixation to achieve stable reconstruction. Despite the severity of injury and initial physiological compromise, the patient achieved a favorable outcome with preserved neurovascular function and early return of joint mobility. At the six-month follow-up, there was satisfactory functional recovery of both the shoulder and elbow. This case is notable for the rare combination of injuries and highlights the importance of systematic trauma management, careful operative planning, and a multidisciplinary approach to rehabilitation. It also underscores the ethical considerations involved in urgent decision-making when treating an intoxicated patient who lacks capacity.