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

Abstract

Purpose The purpose of this study was to determine the location of the anterior humeral circumflex artery and axillary nerve based on bony landmarks, and to provide anatomical information that enables a safe approach when treating a proximal humeral fractures. Methods Thirty cadavers were included. The distances of both the anterior humeral circumflex artery and the axillary nerve from body landmarks were measured using Vernier calipers. Results The mean distance between the inferior border of the medial acromion and the superior border of the anterior humeral circumflex artery was 5.1±0.2 cm (range, 4.6-5.5 cm); the mean distance between the prominence of the lesser tuberosity and the superior border of the anterior humeral circumflex artery was 2.5±0.2 cm (range, 2.0-3.0 cm); the mean distance between the anterior-inferior border of the acromion and the superior border of the axillary nerve was 6.3±0.5 cm (range, 5.2-7.0 cm). Conclusions The artery is located approximately 5.1 cm below the inferior border of the medial acromion and 2.5 cm below the prominence of the lesser tuberosity, and the nerve was located approximately 6.3 cm below the anterio-inferior border of the acromion and 3.5 cm below the prominence of the greater tuberosity. The reduction manoeuvres should be conducted with extreme care in this region.

MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation

“…The average greater tuberosity distances reported by Chen et al and Gardner et al were within 1 mm of our findings along with their reported average trans-humeral ANVB angles which both within 2.5 degrees of our measurements. 8 , 15 Finally, comparing our inferior articular margin measurement to the only literature report by Bono et al, we reported the average distance being about 4 mm less with a much smaller range and standard deviation. These findings support the assessment of ANVB positioning using advanced imaging.…”

“… 35 , 40 EMG identified axillary nerve injuries have been as high as 42% with the deltopectoral approach and 33% with the deltoid splitting approach. 8 A systematic review identified a 3% injury with a deltopectoral approach and a 7% injury the anterolateral deltoid splitting approach. 53 These studies are limited by low numbers and the need for electrophysiologic testing.…”

“… 38 The posterior humeral circumflex artery courses with the axillary nerve and inadvertent injury of this vessel can lead to avascular necrosis of the humeral head. 5 , 8 , 9 Injury to the NVB can have devastating effects on patients’ functional status. 17 Despite concerns for injury to the ANVB, the frequency of injury either after initial injury or surgical intervention is difficult to quantify in the literature.…”

Anatomical study of simple landmarks for guiding the quick access to humeral circumflex arteries

“…The PCHA was considered classic if it arose from the third part of the axillary artery and traveled posteriorly around the proximal humerus. The ACHA was defined as classic if it arose from the third part of the axillary artery and followed a horizontal course to the bicipital groove [ 12 , 13 ].…”

Structures Endangered During Minimally Invasive Plate Osteosynthesis of the Upper Extremity

“…The AHCA branches off the axillary artery at the lower border of the subscapularis and follows a horizontal course behind the coracobrachialis muscle to the bicipital groove approximately 5 cm below the inferior border of the acromion. 21 The ascending branch (arcuate artery) of the AHCA ascends on the lateral border of bicipital groove and enters the proximal humerus at the level of the greater tuberosity. 22 The greatest risk to the axillary nerve occurs during the initial dissection after the two heads of the deltoid muscle have been split.…”