The arteries of the humeral head and their relevance in fracture treatment

Abstract

Bone vascularisation has gained increased interest in relation to the blood supply of bone fragments during treatment of fractures. In the current study the pattern of vascular supply of the proximal humerus was studied in six cadavers by the corrosion technique. Furthermore, the effect of fractures on the vascular supply was also investigated. In all preparations the intraosseous arteries of the humeral head arose from the circumflex arteries, which surrounded the humerus and dispatched branches towards the proximal end. The main vessel was the branch of the anterior circumflex artery, penetrating the major tubercle in six of six cases. Due to the intraosseous arch shape of this vessel it is referred to as the arcuate artery. Besides other smaller vessels, there was also a vascular network arising from the posterior circumflex artery. Their branches penetrated medially at the cartilage bone interface in five of six preparations. The medial bone arteries appear to gain distinctive importance in humeral head fractures by their impact on the vascularisation of the fracture fragments. After disruption of the arterial supply from the arcuate artery, the vascularisation of the head fragments is most likely ensured by this group of vessels. Therefore, necessary repositioning manoeuvres during open reduction of the fracture should be conducted with care in order to preserve these arteries.

The relevance of the anatomical basis of fracture for the subsequent treatment of the anterior humeral circumflex artery and the axillary nerve

“…1 The location where extreme care should be taken to protect the anterior humeral circumflex artery (point 1). Point 2 shows the prominence of the lesser tuberosity Injury to this artery, along with the axillary nerve, is common during surgical procedures to the shoulder and poses a risk to the rich network of anastomoses in the posteromedial humeral epiphysis [6,7,9]. Therefore, the objective of this study was to investigate the anatomy of these structures to improve understanding of "safe zones" during operations.…”

“…Previous cadaver studies of the arterial anatomy of the humeral head have focused on the arterial supply to the humeral head [6,7] but have not established the location of the humeral circumflex arteries with respect to bony landmarks. The path of the axillary nerve has been described [8], and findings from the present investigation will be compared to these results.…”

Mediale Abstützung mit kortikalem intramedullärem Interponat bei winkelstabiler Plattenosteosynthese der proximalen Humerusfraktur

“…Biomechanisch ist dieses Verfahren der winkelstabilen Plattenosteosynthese jedoch unterlegen [11]. Weiterhin kann die ventrale Platte bei unvorsichtiger Positionierung die aus der A. circumflexa humeri anterior abgehende A. arcuata kompromittieren [21].…”

“…The importance of correct reduction of the medial cortices, the use of calcar screws, the double-plate fixation method as well as the presented technique of intramedullary augmentation are discussed. Aufgrund der umliegenden neurovaskulären Strukturen [10,21] …”

Proximal humeral fractures

“…16,25 On the other hand, new progress in PHF studies, especially in vascularization, allows the definition of important new characteristics for treatment decision-making. [26][27][28][29][30] Because important new concepts for prognosis and treatment of PHF do not easily fit in past classification systems, some authors have proposed new imaging techniques 8,12 or new functional classifications. 14 Since 2003, new systems of fracture classifications have been published.…”