THE EXTRAOSSEOUS AND INTRAOSSEOUS ARTERIAL ANATOMY OF THE ADULT ELBOW

We investigated the extraosseous and intraosseous arterial anatomy of the human adult elbow Twenty-two fresh admit cadaveric upper extremiti es were studied with a technique of combined India-ink and latex injec tion followed by chemical debridement. The intraosseous vascularity of twelve extremities was then evaluated with a rapid Spalteholz clearin g technique. Our findings demonstrated consistent patterns of extraoss eous and intraosseous vascular anatomy, which were organized into thre e vascular arcades: medial, lateral, and posterior. The medial arcade was formed by the superior and inferior ulnar collateral arteries and the posterior ulnar recurrent artery. The lateral arcade was formed by the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. The posterior arcade was formed by the medial and lateral arcades and the middle collateral artery The intraosseous circ ulation of the elbow, which was segmental in organization, appeared to be dependent on the local blood supply. The capitellum and the latera l aspect of the trochlea were supplied by posterior perforating vessel s arising from the radial recurrent, radial collateral, and interosseo us recurrent arteries. The medial aspect of the trochlea was supplied by a circumferential vascular ring originating from the inferior ulnar collateral artery. Watershed areas were apparent between the blood su pplies to the medial and lateral aspects of the distal end of the hume rus. The olecranon was richly supplied by vessels coursing along its m edial aspect from the posterior ulnar recurrent artery and along its l ateral aspect from the interosseous recurrent artery. The radial head had a dual extraosseous blood supply from a single branch of the radia l recurrent artery, which supplied the head directly, and from additio nal vessels from both the radial and the interosseous recurrent artery , which penetrated the capsular insertion at the neck of the radius. C LINICAL RELEVANCE: Our findings demonstrate that arterial contribution s to the intraosseous circulation of the elbow are more specific than previously appreciated. The intraosseous circulation of the elbow is d erived mainly from perforating vessels that arise from neighboring ext raosseous arteries. These perforating arteries may be damaged by traum a or by extensile dissection during reconstruction of the elbow. An un derstanding of the extraosseous and intraosseous circulation of the el bow may help to avoid iatrogenic injury to the intraosseous circulatio n.