Preoperative Computed Tomography Angiography to Prevent Vascular Injuries in 4-Part Proximal Humerus Fracture-Dislocations

Cases: This study compares 2 cases of 4-part proximal humerus fracture-dislocations managed by reverse total shoulder arthroplasty: one with significant medialization and acute surgical management and another with mild medialization and delayed surgical management. Both presented with normal vascular examination; however, computed tomography angiography (CTA) revealed vascular involvement necessitating thoracic or vascular surgery consultation. Conclusion: Although vascular injuries are rare, they should be considered in patients with complex injuries, particularly those with delayed treatment or medialization of a bony structure. Our cases highlight important fracture characteristics where a preoperative CTA should be considered even with a normal vascular examination.