Proximal Humeral Fracture Complicated by Axillary Artery Occlusion and Axillary Nerve Palsy Following a Low-Energy Fall: A Case Report

Proximal humeral fractures complicated by a vascular injury are rare but potentially limb-threatening, requiring prompt recognition and coordinated multidisciplinary management.We report the case of a 67year-old right-hand-dominant male who sustained a displaced proximal humeral fracture following a lowenergy mechanical fall and subsequently developed acute upper limb ischaemia secondary to axillary artery occlusion caused by an intimal tear, accompanied by axillary nerve dysfunction.Crucially, the limb remained pink and free of ecchymosis throughout the initial assessment period, illustrating how robust shoulder girdle collateral circulation can maintain distal perfusion despite significant proximal arterial compromise.Early CT angiography (CTA) identified the arterial injury and facilitated an expedited transfer to a tertiary centre.The patient underwent emergency axillary artery repair (thrombectomy, limited endarterectomy and bovine pericardial patch angioplasty), along with prophylactic upper limb fasciotomies, followed by staged reverse total shoulder arthroplasty (RTSA).This report highlights the critical importance of serial neurovascular assessment in proximal humeral fractures and underscores that preserved limb coloration, the absence of ecchymosis, and a faint distal pulse must not be considered reassuring findings that exclude significant vascular injury in the presence of other clinical warning signs.