Delayed presentation of a pseudoaneurysm of the subclavian and axillary artery – the importance of vigilance

Proximal humeral fractures are common injuries, especially in the elderly population. Palvanen et al.1 found an increase in the incidence of these injuries of 13.7% per year with an overall five times increase in their incidence between 1970 and 2002. These injuries are generally caused by falls and more than 70% of these patients are over 60 years of age. Seventy-five percent of these injuries occur in women. Most fractures of the humerus in the elderly are treated conservatively. Most of these patients are either discharged from the Emergency Department and followed up as outpatients or admitted to a rehabilitation ward without further surgical review or reassessment of the neurovascular status of the affected limb. Vascular complications of these injuries are rare, and tend to present acutely. We discuss a case of delayed presentation of a pseudoaneurysm of the subclavian and axillary arteries after a proximal humerus fracture which was treated conservatively. The pseudoaneurysm evolved over a period of two days and required emergency vascular surgical intervention upon diagnosis. This case highlights why these injuries should be managed with a high degree of vigilance, reviewed regularly and referred early for specialist input. It emphasizes the absolute necessity of thorough neurovascular examination when assessing these patients.