The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.
Introduction: Metacarpal fractures are frequent injuries in the young male working population and the majority are treated non-operatively. There is a growing trend to surgically treat these fractures, with the aim of reducing the deformity and shortening the rehabilitation period. The aim of this retrospective case series is to report on our experience and clinical outcomes of using percutaneous flexible locking nails for the management of displaced metacarpal fractures. This study is a retrospective review of 66 fractures that were managed at our centre over a 7-year period. Materials and Methods: Records of 60 patients were retrospectively reviewed. Indications for surgery were a displaced metacarpal shaft or neck fracture with associated rotational deformity, or multiple metacarpal fractures. The fracture was reduced by closed manipulation, and a flexible pre-bent locked intramedullary nail (1.6mm diameter) was inserted through a percutaneous dorsal antegrade approach, facilitated by a specially designed pre-fabricated awl. The implant was removed at union. Patients were followed-up in clinic until the fracture had united. Results: The mean union time was seven weeks (range 2 to 22 weeks) and there were nine (14%) delayed unions (>3 months) and no non-unions. The nail had migrated in three cases (5%) and caused skin impingement in two cases (3%). There was one infected case (2%). Rotational clinical deformity was evident for two (3%) cases. Conclusion: The use of a minimally-invasive locked intramedullary nailing for unstable metacarpal fractures has a significantly low complication rate, with predictable union times and good functional outcomes.