Axillary approach for a proximally displaced humeral head adjacent to the axillary neurovascular bundle: A case report

Background Vascular compression associated with proximal humeral fracture-dislocation is rare; however, severely displaced fragments may place adjacent neurovascular structures at risk. Case presentation An 83-year-old woman presented with a left proximal humeral fracture-dislocation. Imaging demonstrated that the displaced humeral head fragment was compressing the axillary neurovascular bundle. An axillary approach was selected to allow safe fragment removal while protecting the axillary neurovascular bundle, followed by reverse shoulder arthroplasty. No intraoperative vascular injury occurred, and the postoperative course was favorable. Conclusion In proximal humeral fracture-dislocation cases in which the displaced fragment lies adjacent to the neurovascular bundle, an axillary approach may facilitate safe fragment removal while minimizing the risk of vascular injury. This selective strategy may be a useful option in carefully chosen high-risk cases.