ABSTRACT
@#Introduction: Accurate diagnosis of undisplaced periprosthetic femoral fracture (PFF) after hip arthroplasty is crucial, as overlooked PFF may affect its treatment and prognosis. The undisplaced PFF is often difficult to distinguish from radiolucent lines of nutrient artery canal (NAC) of the femur present on post-operative radiographs. We aimed to identify the radiographic features of NAC to distinguish them from PFFs. Materials and methods: In this retrospective radiological study, a total of 242 cases in 215 patients with hip arthroplasty were analysed using pre-operative and postoperative anteroposterior (AP) and translateral (TL) radiographs. Interobserver agreement of the measurements was assessed by two independent experienced orthopaedic surgeons. The kappa value ranged from 0.83 to 0.87, indicating strong agreement according to the Landis and Koch criteria. Results: The NACs were found pre-operatively in 94 (39.8%) cases on AP views and in 122 cases (50.4%) on TL views. The radiolucent lines were observed post-operatively in 42 (17.4%) on AP views and 122 (50.4%) on the TL views. three cases (1.2%) had a fracture around the stem that were detected on radiographs. One case with PFF presented simultaneously with NAC on the immediate post-operative radiographs. All patients were treated by conservative measures, and the radiolucent lines did not appear on followup radiographs. Conclusion: It is not easy to differentiate undisplaced PFFs that can occur after hip arthroplasty operation from NACs. However, accurate diagnosis is possible through careful observation and comparison of pre-operative and postoperative radiologic images
ABSTRACT
Background: The knowledge of variations in the position of nutrient foramina and hence nutrient arteries isimportant for orthopedicians and radiologists for various procedures.Introduction: The major blood supply to long bones occurs through the nutrient arteries, which enter through theforamina called nutrient foramina. The blood supply from nutrient artery is essential during the growing period,also during the early phases of ossification, and in procedures such as bone grafts, transplant techniques inorthopaedics. The present study analyzed the position and number of nutrient foramina in the diaphysis of fiftyadult femora.Aim: to determine the number, direction, position of nutrient foramen and whether the nutrient foramina obeythe general rule that is, directed away from the growing end of the boneMaterials and Method: The present study has been undertaken in Fifty dry adult femora of South Indian origin inthe Department of Anatomy, M.S Ramaiah Medical College, Bangalore. The number, directions, position of nutrientforamen in femur were measured with a digital Vernier caliper. The data were tabulated as mean + SD andstatistically compared between the right and left sides.Results: A total of 75 foramina were examined in the 50 bones. 40 in Right sided femur and 35 in left sided femur.46% bones had single foramina and 52% bones had double foramina. Foramen was absent in 2% bones. Allnutrient foramina in the femur were directed proximally, away from the growing end. 16% of the foramina werelocated in the proximal third of the bone and the rest 84% were located in the middle third of the bone. There wasno significant difference in location of foramina between right and left sided bones.Conclusion: This study will provide the ethnic data for comparison among various populations. It is also helpfulin interpretation of radiological images and for orthopedic procedures. Precise knowledge of usual and anomalousposition of nutrient foramina and hence the nutrient artery may help the orthopaedician for the internal fixationat appropriate place in the long bone. The location of nutrient foramen is important for bone grafts, tumourresections, in traumas, congenital pseudoarthrosis and more recently in microsurgical vascularised bonetransplantation
ABSTRACT
Background: An understanding of the location, number, direction and size of nutrient foramina in long bones isvery important clinically, especially in orthopaedic surgical procedures such as fracture repair, bone grafting,vascularized bone microsurgery, intramedullary reaming and plating,as well as in medico legal cases. An accurateknowledge of the location of the nutrient foramina in long bones should help prevent intraoperative injuries inorthopaedic, as well as in plastic and reconstructive surgery.Aims & Objectives: The aim of our study is to observe the variations in number, location, direction and size of thenutrient foramina of Dried Human Femur.Materials and Methods: The study comprised 200 dry normal adult femur bones of unknown sex obtained fromthe Department of Anatomy of various medical colleges of Telangana, India.Results: The total number of nutrient foramina obtained in 200 femurs was 326. 82 bones had single nutrientforamen (41%), 111 bones had double nutrient foramina (55.5%), 6 bones had triple nutrient foramina (3%), andonly 1 bone 4 nutrient foramina (0.5%) and none of the bones showed zero foramen. The size of nutrient foraminawere also noted in 200 bones, 60 bones presented small sized foramina (18%), 130 bones presented with mediumsized foramina (40%), and rest of 136 bones presented with large sized foramina (42%). The nutrient foraminaobeyed the general rule that is, directed away from the growing end of the bone. Among 326 nutrient foramina149 were located on posterior surface (46%), about 126 foramina were located on medial surface (38.50%), 38were located on the lateral surface (12%), and the remaining 12 were located on the popliteal surface (6%), andnone on the anterior surface.Conclusion: Knowledge of the localization and number of the nutrient foramina is useful in certain surgicalprocedures such as bone grafting and microsurgical vascularized bone transplantation, to preserve the circulationintact and for open reduction surgeries.
ABSTRACT
Background: A Nutrient Foramen [NF] or vascular channel is a small tunnel in cortex of long bones which is apathway for the entry of nutrient artery. Nutrient artery has pivotal contribution of blood supply to long bonesand plays a major role in Orthopaedic Surgical procedures like bone transplantation, bone grafting thus avoidingavascular necrosis of fractured bonesAims: To determine morphological parameters (variation in number, location, direction) and morphometricparameters (variation in size and foraminal index [FI] ) of nutrient foramina in Humeri.Materials and methods: Present study was conducted on a total of 80 dried human adult Humeri of either sexesor sides which were obtained from fellow students and Department of Anatomy of ESIC medical college &PGIMSR, Bangalore. Infantometer was used to calculate length of humeri, hand held lens was used to detectnutrient foramen under adequate illumination. Hypodermic needles [18G to 26G, where G is gauge], were used tomeasure the size of NF. Foraminal index was also calculated.Results: In our study mean length of humerus was 29.95cm.FI ranged from 39.34 -81.02.Majority (62.50%) ofhumeri have one NF, (28.75%) have two NF,(7.5%) with three nutrient foramina and (1.25%) had no NF. Majority ofNF (43.43%) were present on antero-medial surface, (37.37%) on medial border, (14.14%) on posterior surface,(2.02%) on both anterolateral surface and anterior border, 1.01% in lateral border. (90.09%) of NF were locatedin Zone II (middle third), (8.08%) in Zone III (lower third) and (1.01%) in zone I (Upper third). Majority (41.41%)were of large gauge, (34.34%) of medium gauge and (24.24%) of small gauge. All NF directed towards distal endof humerus.Conclusion: For healing of fractures, blood supply plays a vital role. Awareness about variations in NF isimportant because damage to nutrient artery due to any cause like trauma, road traffic accidents will causeinadequate blood supply .Thus vascular and bone transplant surgeons can reconstruct damaged artery andavoid ischemia of graft during open reduction procedures and transplant surgeries.
ABSTRACT
Aim: The aim of the study is to determine the variations in diaphyseal nutrient foramen(NF) of femur with respect to theirnumber, location, direction and size in Jharkhand state population.Materials and Methods: 70 dry adult femora(38 Right side and 32 Left side) were collected from the department of Anatomy,Mahatma Gandhi Memorial Medical College, Jamshedpur, Jharkhand. Femora were examined for mean length of femur, number,position including foraminal index, direction and size of nutrient foramina.Result:- Mean length of femur was 42.27cm. According to Foraminal Index the location of nutrient foramina were 72.34% inright side and 86.84% were located in left side in middle 1/3 of bone. Most common position was between two lips of Lineaaspera(42.35%). Single nutrient foramen was 64.70%.Conclusion:- The knowledge of anatomical variation in diaphyseal nutrient foramen of femur is important for bone ossification,bonehealing and it also give additional information to orthopedicians for microvascular bone grafting.
ABSTRACT
Introduction: The foramina which leads into a canal on the shaft, through which the vessels enter to supply themedullary cavity is called nutrient foramina. The major source of blood supply during the bone growth anddevelopment is by nutrient artery.Materials and methods: The study was conducted on 218 adult humerii. The number, direction and location ofnutrient foramen were observed with the help of a hand lens. The Total length of humerus, distance of the nutrientforamen from its upper end, Location of the nutrient foramen with respect to the surfaces, zones and the foramenindex were noted.Results: It was observed that 81.19% of the humeri had a single nutrient foramen, 18.35% double foramen, 0.45%triple foramen, where as 3.67% humeri did not have any nutrient foramina. The majority (82.11%) of the nutrientforamina were present on the antero-medial surface, 14.22% on the medial border and 9.63% on the anterolateral surface,7.8%on the posterior border and 0.46% on anterior border of the shaft of humeri. The foramenindex was observed to be 56.35 ±7.36 on right side and 55.57±8.5 on left side, indicating the zonal distributionof foramina in the middle third of the bone.Conclusion: With the increasing number of fracture cases due to various causes, the knowledge of nutrientforamina is of much importance in bone reduction and grafting techniques. The present study adds to theexisting data on nutrient foramina especially in the population of Telangana region.
ABSTRACT
Introduction: The Femur bone is a highly vascular structure with unique features in its blood supply via numerous foramina located over its different segments, being named as vascular foramina . Among vascular foramina, nutrient foramen is an important one which gives way to the nutrient artery. Aim: To evaluate the nutrient foramina of the dry adult human femur bone of north Indian population. Subjects and Methods: The present study was undertaken using 50 dry adult human Femur bones of North Indian population. The samples were collected from the Anatomy department of the institute. Results: In the present study, among foramina of 50 dry adult human Femora, 31 Femora had single nutrient foramen, 18 had two nutrient foramina and 1 had three nutrient foramina. The medial lip of lineaaspera of Femur depicted the presence of nutrient foramina in majority of bones suggesting the entry zone for nourishment of shaft by perforating arteries. Size of nutrient foramina were ranging from size ≥ 0.55 mm to size ≥ 1.27 mm. Direction of nutrient foramina of all the Femora were directed upwards. Conclusion: This study may help orthopaedic surgeons in planning the surgical treatment of fracture of Femur with a possible reduction in post-operative complications. Combined periosteal and medullary blood supply to the bone cortex helps to explain the success of intramedullary reaming of long bone fractures particularly in the weight bearing Femur.
ABSTRACT
Introduction: Knowledge of position of nutrient foramina of long bones can be useful in certain surgical procedures. Bone ossification, growth and healing depend on its vascularity. Nutrient artery is the main source of blood supply of bone along with periosteal arteries. The topographical knowledge of these foramina is useful in certain operative procedures, in orthopedics as well as in plastic and reconstructive surgeries.AIM: The present study aims to determine the number and position of nutrient foramen of tibia and fibula and to observe direction and obliquity of nutrient foramina. Subjects and Methods: 100 adult dry bones including 50 tibia and 50 fibula were studied. Nutrient foramina were identified with naked eyes. The obliquity was determined with hypodermic needle. The nutrient foramina location was determined by dividing total bone into segments, the locations were validated by calculating foraminal index. Results: It has been observed that 98% (49) tibia has single nutrient foramina, double nutrient foramiana present in 2%of tibia. Most of the nutrient foramina in tibia are present in upper third i.e 65%(33).Foramina index of tibia is 45.05 with standard deviation of 8.29.In fibula single foramen was observed in 46(92%) and double foramina 2(4) and there is no nutrient foramen in 2(4). In 2 fibulae having double nutrient foramen, proximal foramen was directed downward and distal foramen was directed upwards. In 50%(25) nutrient foramina is present in posterior surface,most of nutrient are in middle third 48(96%).mean foraminal index of fibula is 45.05 with standard deviation of 8.29. Conclusion: Our study has attempted to put together findings from different studies regarding the number and position and obliquity of nutrient foramina of leg bones .The present study will be useful for orthopedic surgeons during procedures like bone grafting and more recently microsurgical vascularised bone transplantation and new graduates to understand the importance of nutrient foramina of long bones.
ABSTRACT
Background: The major blood supply of long bone is from the nutrient arteries, these nutrient arteries enter thebone through a foramen called nutrient foramen. This is an opening into the shaft of a bone. Nutrient foramengives passage to the blood vessels of the bone. The nutrient foramen has a particular position for every bone andthe direction of foramen is away from growing end of bone.Objective: The aim of the present study was to study the anatomy and morphology of the nutrient foramina inhuman lower limb long bones.Materials and Method: The study was performed on 120 lower limb long bones which included 40 femur, 40 tibiaand 40 fibula. The bones were obtained from department of anatomy, R.K.D.F Medical college hospital & researchcentre and R.K.D.F Dental college & hospital Bhopal.Results: The variations were found in number and position of nutrient foramen in different lower limb longbones. Double and triple foramina were observed in femur. In few lower limb long bones nutrient foramen wasabsent.Conclusion: The knowledge of these foramina is useful in orthopaedics certain operative procedures as well asin plastic and reconstructive surgery, to avoid harm to the nutrient artery.
ABSTRACT
Background: Bone formation, growth and its vitality necessitates blood supply. Nutrient artery is the key sourceof blood supply to the long bone apart from the other important sources like periosteal, metaphyseal andepiphyseal arteries. Nutrient foramina allows nutrient artery. Typically, the direction of the nutrient foramina istowards the elbow joint in radius, away from its growing end. Knowledge of foramen index, number, directionand size of the nutrient foramina assists the surgeon to take an exact section of bone in case of bone resectionand transplantation techniques.Aim: The aim of the present study is to determine the number, position, size, direction of the nutrient foraminaand the Foramen Index of the human dry radius bonesMaterials and Methods: In the present study, 91 right sided and 88 left sided radius bones of unknown age andsex were taken into consideration from the department of anatomy, Mamata Medical College, Khammam,Telanagana.Results: Average length of the radius on the right side was observed to be 23.72 ± 1.93 cm and on left side 23.35± 1.75 cm. The foramen index on right side was 34.92 ± 4.97 cm where as on the left side 34.79 ± 4.43 cm. Thenutrient foramen was directed towards the proximal end of radius in all the bones studied. Most of the foramenwere observed on the anterior surface of the bone. Nutrient foramina was found to be absent in 4 right sided and3 left sided bones.Conclusion: This study may add to the present statistical data available on foramen index, number of foramenand their location in the population of Telangana region, during recent orthopaedic techniques like bone resectionand transplantation
ABSTRACT
Objective To evaluate the relation between peripheral nutrient artery and expression of C-erbB-2 in breast invasive ductal carcinoma(IDC) . Methods The peak systolic velocity(PSV) and resistive index ( RI ) of peripheral nutrient artery of tumor in 122 cases with breast IDC and 138 cases with fibroadenoma which proved by operation and pathology were analyzed retrospectively . The C-erbB-2 was measured by immunohistochemical test ,according to the results of immunohistochemical examination ,the masses were divided into negative group( -) ,weakly positive group( + ) ,positive group( + + ) and strong positive group( + + + ) . The relationship between the classification of C-erbB-2 expression and the two factors of peripheral nutrient artery in breast tumor mass were analysed . Results The PSV of trophoblastic artery in IDC group was ( 20 .99 ± 8 .14 ) cm/s , RI 0 .66 ± 0 .07 , the PSV of trophoblastic artery in fibroadenoma group was (15 .56 ± 3 .68)cm/s ,RI 0 .66 ± 0 .07 ,there was significant statistically difference in peripheral nutrient artery of tumor between the breast IDC and fibroadenoma( P < 0 .001) . The RI and PSV of the peripheral nutrient artery in IDC were correlated to the classification of C-erbB-2 expression ( r=0 .323 ,0 .360 ,respectively) ,there was no correlation between the RI and PSV of peripheral nutrient artery in fibroadenoma and the classification of C-erbB-2 expression ( r = 0 .001 ) . Conclusions The spectrum form of peripheral nutrient artery in IDC is high speed and high resistance . The RI and PSV of the peripheral nutrient artery in IDC are correlated to the classification of C-erbB-2 expression .
ABSTRACT
Background: The major blood supply to long bone is from the nutrient arteries, which enter through nutrient foramina. Nutrient foramen is an opening into the bone shaft which give passage to the blood vessels of the medullary cavity of a bone The direction of the nutrient foramen of all bones is away from growing end and has a particular position for each bone. Objective: The aim of the present study was to study the topographic anatomy and morphology of the nutrient foramina in human adult lower limb long bones. Material and Method: The study was performed on 150 lower limb long bones which included 50 femora, 50 tibiae and 50 fibulae. The bones were obtained from department of anatomy, Punjab Institute of Medical Sciences, Jalandhar. Results: The variations were found in number and location of nutrient foramen in different lower limb long bones. In femur double and triple foramina were observed. Absence of nutrient foramen was observed in femur and fibula. Conclusion: The topographical knowledge of these foramina is useful in certain operative procedures, in orthopedics as well as in plastic and reconstructive surgery, to avoid damage to the nutrient vessels.
ABSTRACT
The major blood supply to long bones occurs through the nutrient arteries, which enter through the nutrient foramina. This supply is essential during the growing period, during the early phases of ossification, and in procedures such as bone grafts, tumor resections, traumas, congenital pseudoarthrosis, and in transplant techniques in orthopaedics. The present study analyzed the location, direction, size and the number of nutrient foramina in the diaphysis of 180 long bones of the upper limbs of adults: 60 humerus, 60 radius, 60 ulna. The location of the nutrient foramina is predominant on the anterior aspect of the upper limb long bones. The majority of the bones studied had a single nutrient foramen, which may represent a single source of blood supply. The mean foraminal index for the upper limb bones was 55.4% for the humerus, 34.7% for the radius, and 36.0% for the ulna. This study recorded data that may help in surgical procedures and in the interpretation of radiological images.
ABSTRACT
Non-union of the humeral shaft remains a difficult clinical problem and it may appear after any method of treatment; closed or open reduction. For this reason the precise location of nutrient foramen of humerus and relevant anatomy should be known. The anatomy of the nutrient foramina of humeral diaphysis has been studied in 200 human humeri. Measurements were taken with the help of osteometric board and observations were noted. In present study 77% foramina were found medially; on ulnar border & anteromedial surface (zone A & B). The mean position of nutrient foramen lies distal to the mid-point of humerus (mean 1.5 cm distal, vertical zone III). Of 200 humeri, 63% had a single nutrient foramen which implies that the major blood supply to humeral shaft will enter at one particular point. Knowledge of the anatomy of nutrient foramina is significantly important for orthopaedic surgeons doing open reduction of fracture mid shaft humerus, in order to avoid injuring nutrient artery & thereby lessens the chances of delayed or non-union of fracture shaft humerus.
ABSTRACT
The arterial supply of human cervical vertebral bodies (C_3-C_7) was studied in 74 fresh cadavers of different ages by dissection and translucent preparation.1. The cervical vertebral bodies mainly obtain their blood supply from the vertebral artery, but the lower two (C_6-C_7) also receive their blood supply from the branches of the inferior thyroid, the deep cervical, the costocervical trunk, the highest intercostal and the subclavian artery. These arteries form a ladder-like anastomosis on the anterolateral surface of the vertebral bodies, and a rectangular or hexagonal anastomosis on the dorsal surface.2. The nutrient arteries enter the vertebral body from the anterolateral and dorsal aspects. They can be divided into the central branches which reach the center of the body and the peripheral ones which lie on the peripheral part of the body. Each of the central branches appears as a straight, unbranching stem. Their centrifugal terminals at the center of the body are arborized and extend to the upper, lower, left and right part of the body to supply the central core of the vertebral body which corresponds to the area of the nucleus pulposus. The peripheral branches, short and early branched, supply the peripheral part of the vertebral body which corresponds to the area of the annulus fibrous.3. The number of the central branches on the anterolateral aspect varies between 0-3 and that on the dorsal aspect is 0-2. The number of the peripheral branches on the anterolateral aspect is 2-13 and that on the dorsal aspect is 0-6. These branches anastomose with each other within the body of the vertebra. The end artery only appears in the developing cartilaginous regions of the body.
ABSTRACT
The arterial supply of the human scaphoid was studied in 166 specimens ofhands from fresh cadavers of different ages ranging from 6(1/2)months of gestationto 89 years old by injection and clearing techniques.The scaphoid receives its bloodsupply mainly from the radial artery and its superficial palmar branch.There aretwo groups of nutrient arteries,the dorsal and the volar nutrient arteries,enteringthe scaphoid.The dorsal group of arteries which supplies the proximal 70% to 80%of the scaphoid is the main contributor to the intraosseous blood supply.The volargroup of arteries only supplies the distal 20% to 30% of the bone.An explanationfor the cause of scaphoid necrosis following fracture on the basis of the vascularitywas proposed.
ABSTRACT
The number, size, direction and position of the nutrient foramina were investigated in a total of 351 dry cervical vertebral arches of human adults. The position of the nutrient foramina is on the external and internal aspect of the arch and is more or less located in a fixed area, but the exact spot varies considerably. One foramen is more frequent on either aspect. The average diameters of the foramina on the external and internal aspect are 0.34 mm and0.26 mm respectively. The foramina on the external aspect are directed towards the pediele and those of the internal aspect backward.A total of 120 vertebral arches (except the atlas) in 20 fresh cadavers of different ages were used to demonstrate the nutrient arteries by dissection and translucent preparation. All nutrient arteries entering the foramina on the external aspectarise from the deep cervical artery and those of the internal aspect from spinal branches of the vertebral artery. After penetrating the arches, they divide into anterior and posterior branches. The former then subdivides into several branches leading to the pedicle, transverse process, upper and lower articular process, whereas the latter branches off into the lamina and spinal process. The course and distribution of the intraosseous arteries have close relation with the ossification of the arch.Small periosteal arteries penetrate the arch from the external aspect only and have not been found on the vertebral canal side except in the new borns.