Neurovascular injuries associated with proximal humerus fractures: a review of the current literature.

Neurovascular injuries associated with proximal humerus fractures represent a rare yet clinically significant complication with potential for devastating functional outcomes. Their multifactorial etiology encompasses direct trauma from displaced fracture fragments, indirect stretch or compression mechanisms, and iatrogenic causes during surgical management. The close anatomic relationship between the proximal humerus, axillary artery, and brachial plexus predisposes these structures to combined injury patterns that can threaten limb viability. Diagnosis relies on early recognition through meticulous clinical examination and advanced imaging modalities, which enable precise localization and characterization of neurovascular compromise. While most nerve injuries, particularly involving the axillary nerve, demonstrate favorable outcomes with conservative management, vascular injuries demand urgent multidisciplinary intervention to restore perfusion and prevent irreversible ischemia. Despite advances in imaging and endovascular techniques, no standardized management algorithm exists to universally optimize outcomes in these complex cases. This narrative review provides a comprehensive synthesis of current evidence regarding the diagnosis and management of neurovascular injuries associated with proximal humerus fractures, highlights early recognition and coordinated multidisciplinary care as key determinants of outcome and proposes a pragmatic diagnostic and treatment framework to support clinical decision-making.