Blood Supply of the Proximal Humerus

Courtesy: Prof Nabil Ebraheim

 

Blood supply of the proximal humerus

 

1.      The axillary artery gives anterior circumflex humeral artery which anastomose  with posterior circumflex humeral artery.

 

2.      The anterior circumflex humeral artery gives the ascending branch. The ascending branch runs a few millimeters posterior, parallel and lateral to biceps tendon and the bicipital groove.

 

3.      The arcuate artery is the terminal branch of the ascending branch of the anterior circumflex humeral artery. The arcuate artery gives the majority of the blood supply to the humeral head. The arcuate artery is an end artery

 

4.      A proximal humerus neck fracture can be an anatomical neck fracture or surgical neck fracture.

 

5.      Anatomical Neck fracture=Articular piece fracture. This fracture could interrupt the  blood supply and can lead to AVN of the humeral head.

 

6.      Surgical neck fractures have adequate blood supply with relatively low incidence of AVN

 

7.      Comminution of the fracture, dissection and exposure of the fracture and the position of the implant always plays a  major role in the development of avascular necrosis of the humeral head.