Presentation of the microscopic vascular architecture of the radial head using a sequential plastination technique

The purpose of this study was to demonstrate the peri- and intraosseous vascular architecture of the radial head and vascular interaction with surgical implants. Seventeen fresh human cadaveric elbows were sequentially plastinated beginning with arterial injection, followed by block and slice plastination of the whole elbow. With this technique, we obtained completely transparent cadaveric slices in which the peri- and intraosseous vascular architecture could be studied in its neutral position. In six of these elbows, radial head osteosynthesis was imitated with miniplates or fine threaded K-wires. Vascularization of the radial head occurred via branches of the radial recurrent artery on the ventral, lateral, and dorsal sides of the radial head and a branch of the ulnar artery--ramus periostalis ulnaris--medially and dorsomedially. Both arteries create a pericervical arterial ring around the radial neck. A branch of the interosseous artery--R. interosseous recurrence--supports the ventral and dorsal sides of the radial neck and the final branches of the nutrient artery support intraosseous vascularization. Vascular structures were damaged more severely by plates than by screws. The peri- and intraosseous vascularization of the radial head and the interaction between vascularization and the implants was shown. Plate fixation of radial head fractures leads to a higher level of implant-related destruction of the periosseous vascularization than screw fixation. Besides devascularization of the radial head due to the injury leading to a certain risk of fracture nonunion, additional implant-related injuries to the blood supply might increase the chance of radial head fracture non-union.