Brachial Plexus Injury Following Fracture-Dislocation of the Proximal Humerus: A Case Report.

Abstract

Fracture-dislocations of the proximal humerus with brachial plexus injury are exceedingly rare, and although infrequently encountered, it is important to recognize this complication due to its potentially devastating impact. We present the case of a 75-year-old female who sustained the described injury following a fall onto their left arm, demonstrating combined sensory and motor deficits in the radial, median, and ulnar distribution of the left forearm and hand shortly afterward. Immediate management involved closed reduction under anesthesia, resulting in the improvement of neurological symptoms. For definitive management, surgical fixation of the fracture-dislocation is normally recommended in cases with an associated brachial plexus injury. However, due to a range of personal factors, the patient decided against this. Physiotherapy plays an important role in the management of these injuries, aiding mobility and recovery, with another key part of the follow-up being electrodiagnostic studies. These allow the physician to assess the extent of injury, monitor recovery for prognostication, and aid decisions regarding further surgical management. The importance of these studies is highlighted by the finding of severe brachial plexus injury, despite minimal pathological changes on MRI. Rare but significant, it is important to maintain a high index of suspicion for these injuries and consider underlying risk factors, with prompt surgical input required to optimize outcomes. Alongside surgical management, a considered approach must be taken by the anesthetic team, as regional anesthesia can confound post-procedure neurological assessment.