We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers. The only option that includes all the data is 4. Option 1 does not explain the involvement of the wrist and fingers. The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm. "Direct mechanism is possible, as is indirect transmission of forces from the elbow and hand...radial nerve involvement is extremely frequent, reaching an incidence of 10-18% of cases." Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow, and there is no data to suggest double forearm fracture.

We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers. [HIDDEN] Option 1 does not explain the involvement of the wrist and fingers. The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm. "Direct mechanism is possible, as is indirect transmission of forces from the elbow and hand...radial nerve involvement is extremely frequent, reaching an incidence of 10-18% of cases." Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow, and there is no data to suggest double forearm fracture.

65-year-old obese woman who suffers a fall on her hand with her elbow in extension. She presents with arm pain with swelling and functional impotence of the arm and inability to extend the wrist and fingers. It is most likely to present:

Dislocation fracture of proximal humerus.

Diaphyseal fracture of the humerus associated with double forearm fracture.

Diaphyseal fracture of humerus with radial nerve injury.

Humerus fracture

A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding their elbow. Complications may include injury to an artery or nerve, and compartment syndrome. The cause of a humerus fracture is usually physical trauma such as a fall. Other causes include conditions such as cancer in the bone. Types include proximal humeral fractures, humeral shaft fractures, and distal humeral fractures. Diagnosis is generally confirmed by X-rays. A CT scan may be done in proximal fractures to gather further details.

Supracondylar humerus fracture

Mechanism Extension type of supracondylar humerus fractures typically result from a fall on to an outstretched hand, usually leading to a forced hyperextension of the elbow. The olecranon acts as a fulcrum which focuses the stress on distal humerus (supracondylar area), predisposing the distal humerus to fracture. The supracondylar area undergoes remodeling at the age of 6 to 7, making this area thin and prone to fractures. Important arteries and nerves (median nerve, radial nerve, brachial artery, and ulnar nerve) are located at the supracondylar area and can give rise to complications if these structures are injured. Most vulnerable structure to get damaged is Median Nerve. Meanwhile, the flexion-type of supracondylar humerus fracture is less common. It occurs by falling on the point of the elbow, or falling with the arm twisted behind the back. This causes anterior dislocation of the proximal fragment of the humerus.

Humerus fracture

Signs and symptoms After a humerus fracture, pain is immediate, enduring, and exacerbated with the slightest movements. The affected region swells, with bruising appearing a day or two after the fracture. The fracture is typically accompanied by a discoloration of the skin at the site of the fracture. A crackling or rattling sound may also be present, caused by the fractured humerus pressing against itself. In cases in which the nerves are affected, then there will be a loss of control or sensation in the arm below the fracture. If the fracture affects the blood supply, then the patient will have a diminished pulse at the wrist. Displaced fractures of the humerus shaft will often cause deformity and a shortening of the length of the upper arm. Distal fractures may also cause deformity, and they typically limit the ability to flex the elbow.

[Results after internal fixation of humerus distal fractures in patients over than 65 years old].

Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life.

Olecranon fracture

Olecranon fracture is a fracture of the bony portion of the elbow. The injury is fairly common and often occurs following a fall or direct trauma to the elbow. The olecranon is the proximal extremity of the ulna which is articulated with the humerus bone and constitutes a part of the elbow articulation. Its location makes it vulnerable to direct trauma. Signs and symptoms People with olecranon fractures present with intense elbow pain after a direct blow or fall. Swelling over the bone site is seen and an inability to straighten the elbow is common. Due to the proximity of the olecranon to the ulnar nerve, the injury and swelling may cause numbness and tingling at the fourth and fifth fingers. Examination can bring out a palpable defect at the site of the fracture.

Proximal humerus fracture

Signs and symptoms Typical signs and symptoms include pain, swelling, bruising, and limited range of motion at the shoulder. Deformity may be present in severe fractures, however, musculature may cause absence of deformity on inspection. Numbness over the outside part of the upper arm and deltoid muscle weakness may indicate axillary nerve injury. Symptoms from poor blood circulation in the arm is uncommon due to collateral circulation in the arm. Cause Young adults without risk factors usually require significant trauma, such as in the setting of a motor vehicle collision. Older adults more commonly experience proximal humerus fractures after a fall from standing height. Risk factors People with increased risk of falls are more likely to have a proximal humerus fracture, as this is also the most common mechanism of injury. Osteoporosis increases the risk of proximal humerus fractures. Pathophysiology

Median nerve

Injury Injury of median nerve at different levels causes different syndromes with varying motor and sensory deficits. At the shoulder Injury can occur at the brachial plexus Above the elbow Common mechanism of injury: A supracondylar humerus fracture Motor deficit: Loss of pronation of forearm, weakness in flexion of the hand at the wrist, loss of flexion of radial half of digits and thumb, loss of abduction and opposition of thumb. Presence of an ape hand deformity when the hand is at rest, due to an hyperextension of index finger and thumb, and an adducted thumb Presence of benediction sign when attempting to form a fist, due to loss of flexion of radial half of digits Sensory deficit: Loss of sensation in lateral digits including their nail beds, and the thenar area At the elbow Entrapment at the level of the elbow or the proximal forearm could be due to the pronator teres syndrome.

Humerus fracture

Definitive diagnosis of humerus fractures is typically made through radiographic imaging. For proximal fractures, X-rays can be taken from a scapular anteroposterior (AP) view, which takes an image of the front of the shoulder region from an angle, a scapular Y view, which takes an image of the back of the shoulder region from an angle, and an axillar lateral view, which has the patient lie on his or her back, lift the bottom half of the arm up to the side, and have an image taken of the axilla region underneath the shoulder. Fractures of the humerus shaft are usually correctly identified with radiographic images taken from the AP and lateral viewpoints. Damage to the radial nerve from a shaft fracture can be identified by an inability to bend the hand backwards or by decreased sensation in the back of the hand. Images of the distal region are often of poor quality due to the patient being unable to extend the elbow because of pain. If a severe distal fracture is suspected, then a

Supracondylar humerus fracture

Epidemiology Supracondylar humerus fractures is commonly found in children between 5 and 7 years (90% of the cases), after the clavicle and forearm fractures. It is more often occurs in males, accounting of 16% of all pediatric fractures and 60% of all paediatric elbow fractures. The mechanism of injury is most commonly due to fall on an outstretch hand. Extension type of injury (70% of all elbow fractures) is more common than the flexion type of injury (1% to 11% of all elbow injuries). Injury often occurs on the non-dominant part of the limb. Flexion type of injury is more commonly found in older children. Open fractures can occur for up to 30% of the cases. References Bibliography External links Injuries of shoulder and upper arm Bone fractures

Radial nerve dysfunction

Signs and symptoms Anyone experiencing radial nerve dysfunction could also experience any of the following symptoms: Lost ability or discomfort in extending the elbow Lost ability or discomfort bending hand back at the wrist Numbness Abnormal sensations near the thumb, index and middle fingers Sharp or burning pain Weakness in grip Drooping of the hand, also called wrist drop Cause There are many ways to acquire radial nerve palsy. The term Saturday Night Palsy refers to an injury to the radial nerve in the spiral groove of the humerus caused while sleeping in a position that would under normal circumstances cause discomfort. It can occur when a person falls asleep while heavily medicated and/or under the influence of alcohol with the underside of the arm compressed by a bar edge, bench, chair back, or like object. Sleeping with the head resting on the arm can also cause radial nerve palsy. Breaking the humerus and deep puncture wounds can also cause the condition.

Proximal humerus fracture

A proximal humerus fracture is a break of the upper part of the bone of the arm (humerus). Symptoms include pain, swelling, and a decreased ability to move the shoulder. Complications may include axillary nerve or axillary artery injury. The cause is generally a fall onto the arm or direct trauma to the arm. Risk factors include osteoporosis and diabetes. Diagnosis is generally based on X-rays or CT scan. It is a type of humerus fracture. A number of classification systems exist. Treatment is generally with an arm sling for a brief period of time followed by specific exercises. This appears appropriate in many cases even when the fragments are separated. Less commonly surgery is recommended. Proximal humerus fractures are common. Older people are most commonly affected. In this age group they are the third most common fractures after hip and Colles fractures. Women are more often affected than men.

Bone fracture

Rib fracture Sternal fracture Shoulder fracture Clavicle fracture Scapular fracture Arm fracture Humerus fracture (fracture of upper arm) Supracondylar fracture Holstein-Lewis fracture – a fracture of the distal third of the humerus resulting in entrapment of the radial nerve Forearm fracture Ulnar fracture Monteggia fracture – a fracture of the proximal third of the ulna with the dislocation of the head of the radius Hume fracture – a fracture of the olecranon with an associated anterior dislocation of the radial head Radius fracture Essex-Lopresti fracture – a fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint with disruption of the interosseous membrane Distal radius fracture Galeazzi fracture – a fracture of the radius with dislocation of the distal radioulnar joint Colles' fracture – a distal fracture of the radius with dorsal (posterior) displacement of the wrist and hand

Anatomy, Shoulder and Upper Limb, Arm Nerves -- Clinical Significance

The radial nerve can get compressed at the axilla, known as Saturday night palsy.  Injury at this level leads to loss of extension of the forearm, wrist, and fingers combined with sensory loss in the radial nerve distribution. In the arm, the radial nerve can incur damage with a mid-shaft humeral fracture leading to weakness of wrist and finger extension and corresponding sensory loss distally. Damage can also occur in the forearm. [7] [25]

An Uncommon Combination of Fractures around the Elbow: Capitellum Fracture Associated with Radial Head Fracture.

The coexistence of fractures of capitulum humeri and radial head in the elbow joint is a rare entity. A 30-year-old woman was admitted to our hospital after having sustained a fall on her outstretched right arm. She complained of pain, swelling, and restriction of motion of the right elbow joint. Anteroposterior and lateral radiographs revealed displaced fractures in the capitellum and the radial head. The patient was operated. Fractures were exposed through a lateral (Kocher) incision. Fracture was reduced, and fixation was performed with 2 AO compression screw. Two fragments of radial head fracture were also reduced and fixed with AO compression screw. Clinical and radiographic outcomes were excellent at the end of a 5-year follow-up. These fractures occurred following a fall on the palm with outstretched arm. The success of the treatment depends greatly on surgical approach and suitable technique which requires comprehensive knowledge of detailed anatomy and biomechanics of the elbow.

Anatomy, Shoulder and Upper Limb, Hand Thenar Eminence -- Clinical Significance

Supracondylar humerus fractures may also cause this deformity. The anterior interosseus nerve (AIN), a significant motor branch of the median nerve, lies anterior to the supracondylar humerus and is at risk of being stretched, impinged, or pierced during fracture. This type of fracture is most common in children due to falling on an outstretched arm. [7]

Arm

Clinical significance The cubital fossa is clinically important for venepuncture and for blood pressure measurement. When the arm is fractured this may refer to a fracture of the humerus bone. Veins on the arm may be taken when a coronary artery bypass graft is needed. Other animals In other animals, the term arm can also be used for homologous or analogous structures (such as one of the paired forelimbs of a four-legged animal or the arms of cephalopods, respectively). In anatomical usage, the term arm may sometimes refer specifically to the segment between the shoulder and the elbow, while the segment between the elbow and wrist is the forearm. However, in common, literary, and historical usage, arm refers to the entire upper limb from shoulder to wrist. This article uses the former definition; see upper limb for the wider definition.

Anatomy, Shoulder and Upper Limb, Cutaneous Innervation -- Clinical Significance -- Radial Nerve

The radial nerve is particularly disposed to in compression type injuries and humerus fractures due to its proximity to the humerus as it passes through the arm. Fractures to the humerus can cause severe injury requiring repair. It can also suffer an injury due to improper and prolonged use of crutches causing continued pressure on the medial side of the arm or axilla. [3]

Radial nerve

Clinical significance Injury Injury to the radial nerve at different levels causes different syndromes with varying motor and sensory deficits. At the axilla Common mechanisms of injury: Saturday night palsy, crutch palsy, lesions Motor deficit: Loss of extension of forearm, weakness of supination, and loss of extension of hand and fingers. Presence of wrist drop, due to inability to extend the hand and fingers. Sensory deficit: Loss of sensation in lateral arm, posterior forearm, the radial half of dorsum of hand, and dorsal aspect of radial digits, excluding their nail beds. At mid-arm Common mechanism of injury: Mid-shaft humeral fracture Motor deficit: Weakness of supination, and loss of extension of hand and fingers. Presence of wrist drop, due to inability to extend the hand and fingers. Sensory deficit: Loss of sensation in posterior forearm, the radial half of dorsum of hand, and dorsal aspect of radial digits, excluding their nail beds.

Diaphyseal Fracture of the Humerus during Elective Cesarean Section - A Rare Case Report.

Humeral fractures are the second common long bone fractures of the neonatal period after clavicle. Most cases of birth-related humerus fracture are reported during a vaginal breech delivery. The cesarean section does not eliminate the risk of long bone fractures. A humerus fracture is less common but still can happen due to forceful maneuvers like traction during cesarean which can go unnoticed to operating obstetrician or misinterpreted as brachial plexus injury by an inexperienced orthopedic surgeon. We received a call from the neonatal intensive care unit (NICU) for a 2-day-old 2.4 kg male baby delivered to primigravida at 37 weeks by elective cesarean for transverse lie, for not moving his right upper limb. On examination by orthopedic surgeon, swelling, contusion, crepitus, and abnormal mobility at the right arm were noticed. Gentle manipulation made the neonate cry. Range of movements (ROMs) of wrist, elbow, and hand were within normal limit without any neurovascular deficit. Hence, the initial diagnosis of brachial plexus injury/Erb's palsy was revised. X-ray of the right upper limb was ordered which showed an isolated mid-shaft humerus bicortical fracture. A high above elbow slab was applied with an arms chest bandage for a week and the baby was discharged with proper advice to the mother to follow-up on the next week. Obstetricians and pediatricians should remain vigilant for the rare occurrence of humerus fracture during cesarean so that they are not missed and managed timely to prevent future disability and deformity.

The median nerve can become impaired with a supracondylar humerus fracture.  Injury at this level can cause adduction of the wrist, loss of pronation of the forearm, weakness of wrist flexion, loss of thumb flexion, thenar muscle atrophy, and loss of sensation over the corresponding area.  When attempting to form a fist, the radial digits will not flex, resulting in the hand of benediction sign.  At rest, loss of thumb abduction leads to the ape hand deformity.  Distally, the anterior interosseous nerve can be injured, and the median nerve can be damaged at the wrist or compressed within the carpal tunnel. [27]

Supracondylar humerus fracture

to do an "OK" sign; instead a pincer grasp is performed). Radial nerve would be injured if the distal humerus is displaced postero-medially. This is because the proximal fragment will be displaced antero-laterally. Ulnar nerve is most commonly injured in the flexion type of injury because it crosses the elbow below the medial epidcondyle of the humerus.

Radial Head Fractures -- History and Physical

The fracture occurs when a patient has direct traumatic to the elbow or falls with the wrist and the hand in extension. The usual signs are pain and functional impotence, there may be blockages in the elbow.

Radial nerve dysfunction

Radial nerve dysfunction is a problem associated with the radial nerve resulting from injury consisting of acute trauma to the radial nerve. The damage has sensory consequences, as it interferes with the radial nerve's innervation of the skin of the posterior forearm, lateral three digits, and the dorsal surface of the lateral side of the palm. The damage also has motor consequences, as it interferes with the radial nerve's innervation of the muscles associated with the extension at the elbow, wrist, and fingers, as well the supination of the forearm. This type of injury can be difficult to localize, but relatively common, as many ordinary occurrences can lead to the injury and resulting mononeuropathy. One out of every ten patients suffering from radial nerve dysfunction do so because of a fractured humerus.

Distal radius fracture

The most common cause of this type of fracture is a fall on an outstretched hand from standing height, although some fractures will be due to high-energy injury. People who fall on the outstretched hand are usually fitter and have better reflexes when compared to those with elbow or humerus fractures. The characteristics of distal radius fractures are influenced by the position of the hand at the time of impact, the type of surface at point of contact, the speed of the impact, and the strength of the bone. Distal radius fractures typically occur with the wrist bent back from 60 to 90 degrees. Radial styloid fracture would occur if the wrist is ulnar deviated and vice versa. If the wrist is bent back less, then proximal forearm fracture would occur, but if the bending back is more, then the carpal bones fracture would occur. With increased bending back, more force is required to produce a fracture. More force is required to produce a fracture in males than females. Risk of injury

Anatomy, Shoulder and Upper Limb, Brachial Plexus -- Clinical Significance

Ulnar nerve lesion affects the sensation of the medial one and a half digits including the hypothenar eminence. It also causes weakness of wrist flexion, finger abduction and adduction, thumb adduction, and finger extension. Claw hand sign and radial deviation at the wrist are the usual signs. Causes of lesions at the ulnar nerve can be the result of fracture of the medial epicondyle of the humerus, the hook of the hamate (from a fall on an outstretched hand), or the clavicle. [12] [34]

Proximal humerus fracture

They are more common in women than men, and occur more often in older adults. The average age of people who sustain a proximal humerus fracture is 63–66 years. Special populations Children A proximal humerus fracture in a young child may be a sign of child abuse. In older children and adolescents proximal humerus fractures frequently occur in the setting of sports or trauma. Proximal humerus fractures in children can commonly be treated non-operatively due to the large amount of bone growth that occurs at the proximal humerus. In older children where there is less time for bone remodeling, surgery may be indicated more frequently. References Wikipedia medicine articles ready to translate Bone fractures Injuries of shoulder and upper arm

Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario.

Understanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics. Cases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (p < 0.01) in ANOVA were used to identify group differences (age/sex). We identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18-40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group. UE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex.

Humerus fracture

Epidemiology Humerus fractures are among the most common of fractures. Proximal fractures make up 5% of all fractures and 25% of humerus fractures, middle fractures about 60% of humerus fractures (12% of all fractures), and distal fractures the remainder. Among proximal fractures, 80% are one-part, 10% are two-part, and the remaining 10% are three- and four-part. The most common location of proximal fractures is at the surgical neck of the humerus. Incidence of proximal fractures increases with age, with about 75% of cases occurring among people over the age of 60. In this age group, about three times as many women than men experience a proximal fracture. Middle fractures are also common among the elderly, but they frequently occur among physically active young adult men who experience physical trauma to the humerus. Distal fractures are rare among adults, occurring primarily in children who experience physical trauma to the elbow region. References Bibliography External links

Anatomy, Shoulder and Upper Limb, Radial Nerve -- Other Issues

The radial nerve lies in the radial groove of the humerus, making it vulnerable to injury after a humeral shaft fracture. Radial nerve damage at this level can cause wrist drop, a condition notable for the inability to extend the wrist. A lateral supracondylar fracture may also damage the radial nerve but will present differently from a midhumeral injury. Nerve branches to the brachioradialis and extensor carpi radialis longus arise above this fracture so that these muscles are largely unaffected. Instead of presenting with a wrist drop, the patient's wrist weakly extends radially when asked to extend the hand. [16] [20] [21]

InternalMed_Harrison

Radial nerve injury classically presents with weakness of extension of the wrist and fingers (“wrist drop”) with or without more proximal weakness of extensor muscles of the upper extremity, depending on the site of injury. Sensory loss is in the distribution of the radial nerve, which includes the dorsum of the hand (Fig. 463e-3A). Compression at the level of the axilla, e.g., resulting from use of crutches, leads to weakness of the triceps, brachioradialis, and supinator muscles in addition to wrist drop. A more common site of compression occurs in the spiral groove of the upper arm in the setting of a humerus fracture or from sleeping with the arm draped over a bench or chair (“Saturday night palsy”). Sparing of the triceps is the rule when the nerve is injured in this location. Because extensors of the upper extremity are injured preferentially in radial nerve injury, these lesions may be mistaken for the pyramidal distribution of weakness that accompanies upper motor neuron

Proximal Humerus Fracture-Dislocation with Laceration of the Axillary Artery: A Case Report.

Proximal humerus fractures account for approximately 4-6% of all fractures. While the majority of these fractures are treated non-operatively, the amount of fracture displacement, concomitant injuries, and patient factors often result in the need for surgical stabilization. Although concomitant neurovascular injury in the setting of low-energy trauma is rare, injury to the surrounding neurovascular structures have previously been reported. We report a case of a 79-year-old male who sustained a low energy fall resulting in a two-part fracture dislocation of the proximal humerus with an associated brachial plexopathy and axillary artery laceration. The patient underwent emergent open reduction internal fixation of his fracture in addition to an axillary-brachial artery bypass using a reverse-saphenous vein graft. The current article reports the presentation, management and prognosis of this rare injury. At 6 months, the patient demonstrated limited active shoulder abduction with no observed motor function at this elbow, wrist or hand. Radiographic follow up demonstrated a reduced glenohumeral joint with evidence avascular necrosis of the humeral head. Fracture-dislocations of the proximal humerus may be associated with significant neurovascular injury in the setting of low energy trauma. Despite early treatment, the prognosis of patients with this constellation of injuries is guarded.

Injury or damage to the radial nerve could also develop lesions, as seen in Saturday night palsy, where the axilla is mainly affected. This condition is characterized by a wrist drop brought about by the weakened elbow, wrist, and finger extension. Also, there is a loss of sensory function over the posterior arm, forearm, and dorsal hand. Wrist drop presents as a result of compression to the axilla, usually due to crutches or when sleeping with the arm over a chair (Saturday night palsy). It can also happen from a midshaft fracture of the humerus.