The Arterial Supply of the Adult Humerus

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Abstract
It is worth repeating that in all of these bones the periosteum with its rich blood supply had been removed. A true picture of the blood supply can only be obtained by keeping this abundant source of arterial blood in mind. The constancy of the main nutrient artery of the humeral shaft is remarkable. It would appear to be prudent to guard against injuring this vessel in operations on the humeral shaft. The danger of damaging this artery will probably be greatest in open reductions of fractures of the mid-shaft of the bone. Fractures through the shaft at the junction of the middle and lower thirds will probably destroy the main nutrient at the time of injury. The upper end of the lower fragment will then depend for arterial blood supply on vessels entering from the periosteum and those ascending from the epicondyles. Extensive stripping of the periosteum of the lower fragment in open reductions in this region would probably be best avoided. The upper half of the shaft has an excellent blood supply from the ascending branch of the main nutrient artery and from the accessory nutrient arteries. This may account for the predilection of secondary malignant deposits for this part of the bone. The main blood supply of the humeral head enters it anterolaterally above the common site of fractures of the surgical neck. Both bone ends thus have a good blood supply. This may account for the rapidity of union of these fractures. However, in operating on this region, whether for repair of rotator-cuff injuries or for open reduction of fracture-dislocations of the surgical neck, it is perhaps worth while bearing in mind that the main blood supply of the head enters it via the upper end of the bicipital groove or via the adjacent parts of the greater and lesser tuberosities. If damage to these vessels is avoided the viability of the humeral head may be preserved. The importance of preserving muscular and ligamentous attachments when operating on the lower end of the humerus is well known. The size of the posterior arteries entering the epicondyles and condyles is, however, worth bearing in mind. If damage to these posterior vessels is avoided in operations on fractures in this region, the viability of the bone fragments may well be preserved and subsequent degenerative changes in the elbow joint may be avoided. The intramedullary course of the nutrient arteries (Fig. 16) must mean that they will be destroyed by the insertion of intramedullary nails. If at the same time an open reduction of the fractured shaft is performed, periosteal stripping of the bone ends will be inevitable. The blood supply of the shaft would then be unduly jeopardized. Both the branches of the main and accessory nutrient arteries in the medulla and the only possible local collateral circulation, the periosteal vessels, would be destroyed.

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