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Final Program


Final Program

Electrodiagnostic / Neuromuscular Medicine

1617 - Proximal Humerus Plexopathy and Other P's

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Traumatic proximal humerus fracture with axillary artery dissection and brachial plexopathy

Case Description: Proximal humerus fractures are the third most common fracture in adults, comprising 4-6% of all fractures in the elderly and require rapid assessment to rule our neurovascular injury. We present a rare and complex case of an 81-year-old woman who sustained a comminuted four-part proximal humerus fracture with associated axillary artery transection and brachial plexopathy following a ground-level fall. Initial evaluation revealed a cold, pulseless right upper extremity and significant neurologic deficits. Imaging confirmed a complete axillary artery dissection with minimal collateral flow. Emergent surgical intervention was performed with vascular repair via end-to-end anastomosis and Fogarty embolectomy, successfully restoring distal perfusion. Attempted fracture fixation was aborted intraoperatively due to severe osteopenia and fracture complexity.

Discussions: Postoperatively, the patient exhibited profound weakness and numbness of the right arm. MRI and later EMG confirmed severe brachial plexopathy. Given her age, poor bone quality, and neurologic impairment, reverse total shoulder arthroplasty (RTSA) was deemed high-risk due to deltoid dysfunction and prosthesis instability. The patient was managed non-operatively with immobilization, rehabilitation, and close neurologic monitoring.

Conclusions: This case underscores the importance of early vascular assessment and multidisciplinary coordination in proximal humerus fractures with neurovascular compromise, particularly in elderly patients with osteoporotic bone. Axillary artery injury, though rare, can occur even after low-energy trauma and may necessitate urgent intervention. Brachial plexopathy may result from compressive or ischemic mechanisms and significantly impacts prognosis and surgical decision-making. Delaying or avoiding arthroplasty is prudent when deltoid function is compromised. Serial EMG studies can play a critical role in long-term management.