Gerber et al. used selective radiopaque injection and microradiography in 29 fresh cadaveric shoulders to map exactly which arteries supply the humeral head and in what territory. The central question: which vessel is truly dominant, and what does that mean when it is disrupted?
Every proximal humerus fracture you manage carries a risk of avascular necrosis — and Gerber's 1990 paper tells you exactly why. The anterolateral ascending branch of the anterior circumflex artery is the humeral head's lifeline. It enters bone at the proximal intertubercular groove–greater tuberosity junction: a visible, protectable structure.
When you assess fracture displacement, ask whether this vessel has been disrupted at or near its osseous entry point. Injury close to that entry point leaves almost no anastomotic rescue. The collateral network can only compensate from distal to the lesion, not proximal.
This anatomy is why medial calcar integrity and soft tissue hinge preservation (formalized by Hertel et al. In 2004) became the key predictors of osteonecrosis risk after proximal humerus fractures. Gerber's paper also flagged that certain AO-era internal fixation techniques likely compromise this vessel. A warning that shaped modern locking plate design and approach philosophy.
Gerber et al. used selective radiopaque injection and microradiography in 29 fresh cadaveric shoulders to map exactly which arteries supply the humeral head and in what territory. The central question: which vessel is truly dominant, and what does that mean when it is disrupted?
Every proximal humerus fracture you manage carries a risk of avascular necrosis — and Gerber's 1990 paper tells you exactly why. The anterolateral ascending branch of the anterior circumflex artery is the humeral head's lifeline. It enters bone at the proximal intertubercular groove–greater tuberosity junction: a visible, protectable structure.
When you assess fracture displacement, ask whether this vessel has been disrupted at or near its osseous entry point. Injury close to that entry point leaves almost no anastomotic rescue. The collateral network can only compensate from distal to the lesion, not proximal.
This anatomy is why medial calcar integrity and soft tissue hinge preservation (formalized by Hertel et al. In 2004) became the key predictors of osteonecrosis risk after proximal humerus fractures. Gerber's paper also flagged that certain AO-era internal fixation techniques likely compromise this vessel. A warning that shaped modern locking plate design and approach philosophy.