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Journal article

A pedicled bone graft from the acromion: an anatomical investigation regarding surgical feasibility

  • Moor, Beat Kaspar Department of Orthopaedic Surgery, Hôpital cantonal de Fribourg, Switzerland
  • Kohut, Georges Department of Orthopaedic Surgery, Hôpital cantonal de Fribourg, Switzerland
  • Bouaicha, Samy Department of Orthopaedic Surgery, Hôpital cantonal de Fribourg, Switzerland
  • Grabherr, Silke University Center of Legal Medicine Lausanne-Geneva, University of Lausanne, Switzerland
  • Gautier, Emanuel Department of Orthopaedic Surgery, Hôpital cantonal de Fribourg, Switzerland
  • Bergmann, Mathias Institute of Anatomy, Department of Medicine, University of Fribourg, Switzerland
  • Marcer, Nicholas Institute of Anatomy, Department of Medicine, University of Fribourg, Switzerland
  • Djonov, Valentin Institute of Anatomy, Department of Medicine, University of Fribourg, Switzerland
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    02.07.2011
Published in:
  • Journal of Shoulder and Elbow Surgery. - 2011, vol. 21, no. 5, p. 604-611
Acromion
vascularized bone graft
revascularization
acromial branch
thoracoacromial trunk
avascular necrosis
English Objective: To investigate the technical feasibility of harvesting a vascularized bone graft from the acromion pedicled on the acromial branch.Background: Complex fractures of the proximal humerus may result in partial or total avascular necrosis of the head fragment. Treatment of avascular necrosis of the humeral head is dependent upon the stage of disease as well as the dimension and location of necrosis. In general, the outcome is poor and complete restoration of the shoulder function is rarely attained. Contrary to osteonecrosis of carpal bones (where vascularized bone grafts have been routinely carried out for decades), reports of analogous procedures at the humeral head are anecdotal.Methods: Based on selective post-mortem computer-tomographic angiography of 5 and the dissection of 30 embalmed human cadaver shoulders, we describe the anatomy of the acromial branch of the thoracoacromial trunk. The main focus was the constancy of its anatomical course, its dimensions and potential use as a nutrient vessel for a pedicled bone graft from the acromion.Results: The course of the acromial branch revealed a constant topographic relationship to anatomical landmarks. Its terminal branches reliably supplied the anterior part of the acromion. The vascularized bone graft could be sufficiently mobilized to allow tension-free transfer to the humeral head as well as to the lateral two-thirds of the clavicle.Conclusion: We demonstrated the feasibility of vascularized bone graft harvesting from the acromion. This technique could be a joint-preserving procedure for osteonecrosis of the humeral head or may assist in the revision of a clavicular pseudoarthrosis.Level of evidence: Anatomic Study; Cadaver Dissection.
Faculty
Faculté des sciences et de médecine
Department
Département de Médecine
Language
  • English
Classification
Medicine
License
License undefined
Identifiers
Persistent URL
https://folia.unifr.ch/unifr/documents/302027
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