Quantitative localization of the entry point of the lateral ascending branch of the anterior circumflex humeral artery: a high definition CT-scan radiological study.

Abstract

To define the localization of the entry point of the lateral ascending branch of the anterior circumflex humeral artery (LACHA) for better surgical management and prevention of injury to this important vessel. The hypothesis is that the insertion point of the artery will be constant in subjects. A retrospective study of 27 tomographic images was conducted to generate a three-dimensional (3D) model and localize the entry point of the LACHA. Using a coordinate system consisting of three axes: the proximal-distal axis (PDA), the anterior-posterior axis (APA) and the medial-lateral axis (MLA), the position of a foramen located in the superior portion of the bicipital groove and representing the entry point of LACHA was measured on each reconstructed model. On average, the foramen was located 10.0mm distal along the PDA from the most proximal point of the greater tuberosity (GT). Along the MLA and with respect to the most medial portion of the GT, the foramen was located 3.4mm medially, on average. No significant differences between men and women or between sides for foramen position measurements were found. Unnecessary procedures to the proximal biceps, aiming to prevent chronic pain, should be avoided in fracture fixation as they would affect a significant source of blood supply to the humeral head. These findings could help surgeons protect the only vascular supply they can during the fixation of proximal humeral fractures, when using the anterior or antero-lateral approaches.