Avoiding Iatrogenic Axillary Artery Injury in Reverse Total Shoulder for Fracture: The Use of a Separate Axillary Incision: A Case Report.

CASE: A 71-year-old woman sustained a left proximal humerus fracture dislocation. Imaging demonstrated displacement of the humeral head medial to the axillary artery without initial injury. To avoid iatrogenic injury, a separate medial axillary incision was successfully used to remove the humeral head and then reverse total shoulder arthroplasty was performed through a deltopectoral approach. At 1 year, the patient had excellent range of motion and PROMIS Physical Function CAT (v2.0) score was 46.2.

CONCLUSIONS: A separate medial axillary approach can be used to safely remove anterior/inferior humeral head fragments and avoid neurovascular injury in reverse total shoulder arthroplasty for proximal humerus fracture dislocations.