TY  - BOOK
AU  - Abadeer, Andrew 
AU  - Brooks, Daina M
AU  - Giladi, Aviram M
AU  - Higgins, James P
AU  - Shubinets, Valeriy
AU  - Wu, Caroline M
TI  - Arterial Perfusion of the Proximal Phalanx Revisited: New Insights Based on Micro-Computed Tomography
SN  - 0363-5023
PY  - 2022///
KW  - IN PROCESS -- NOT YET INDEXED
KW  - Curtis National Hand Center
KW  - MedStar Union Memorial Hospital
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - Orthopaedic Surgery
KW  - Plastic Surgery Residency
KW  - Journal Article
N1  - Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present
N2  - CLINICAL RELEVANCE: An understanding of the patterns of perfusion of the proximal phalanx provides some insight into clinically observed pathology, as well as guidance for operative management. Copyright © 2022 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved; CONCLUSIONS: Periosteal contributions to the perfusion of the proximal phalanx appear to diminish distally. The endosteal arterial anatomy remains consistent, with a single nutrient vessel entering the intramedullary canal with reliable laterality on each digit. This is often the only vessel supplying the head of the proximal phalanx, making this area particularly susceptible to vascular compromise; METHODS: Cadaveric upper extremities were injected with a barium sulfate/gelatin suspension. Phalanges were imaged using micro-CTA and analyzed with a focus on osseous arterial anatomy. Periosteal and endosteal perfusion was characterized by number of vessels, length, anatomic course, and caliber; PURPOSE: To characterize the periosteal and endosteal arterial perfusion of the proximal phalanx using micro-computed tomography angiography (micro-CTA); RESULTS: The base of the proximal phalanx had a significantly greater number (8.0 +/- 3.5) of periosteal vessels than those of the shaft (4.1 +/- 1.6) and head (1.3 +/- 1.1). One-third (34.4%) of the specimens demonstrated a complete absence of periosteal vessels in the head. A nutrient endosteal vessel was noted in 100% of the specimens. Entering at the junction of the middle and distal third of the bone (25.8 +/- 3.9 mm from base), the nutrient vessel entered the proximal phalanx of the index finger along its ulnar aspect (8 of 8 specimens), the middle finger along its radial aspect (6 of 8), the ring finger along its ulnar aspect (5 of 8), and the little finger along its radial aspect (7 of 8). The nutrient vessel branched into proximal and distal extensions toward the shaft and head, respectively, with an average endosteal length of 10.7 +/- 5.2 mm and average diameter of 0.36 +/- 0.11 mm
UR  - https://dx.doi.org/10.1016/j.jhsa.2022.09.014
ER  -