Assessment of the local blood supply when femoral neck fracture occurs:advances in the anatomy research and its clinical application / 中国骨伤

The stability of internal fixation of femoral neck fractures can be obtained through surgical techniques, the configuration of screws and bone grafting, etc. However, the blood supply injury caused by fractures could not be completely reversed by the current medical management. Hence, the comprehensive evaluation of the residual blood supply of the femoral neck, to perioperatively avoid further iatrogenic injury, has become a hotspot. The anatomy of the extraosseous blood supply of the femoral neck has been widely reported, while its clinical application mostly involved the assessment of the medial circumflex femoral artery and retinacular arteries. However, further studies are needed to explore the prognosis of patients with these artery injuries, with different degrees, caused by femoral neck fractures. Direct observations of nutrient foramina in vivo are not possible with current clinical technologies, but it is possible to make reasonable preoperative planning to avoid subsequent femoral head necrosis based on the distribution features of nutrient foramina. The anatomy and clinical application studies of the intraosseous blood supply focused on the junction area of the femoral head and neck to probe the mechanism of femoral head necrosis. Thus, the intraosseous blood supply of other regions in the femoral neck remains to be further investigated. In addition, a blood supply evaluation system based on a three-level structure, extraosseous blood vessels, nutrient foramina, and intraosseous vascular network, could be explored to assist in the treatment of femoral neck fractures.

A study of morphological and morphometric variations in Sri Lankan femoral diaphysial nutrient foramina / Estudio de las variaciones morfológicas y morfométricas de los forámenes nutricios diafisarios de fémur en Sri Lanka

SUMMARY: Blood supply to the diaphysis of long bones is majorly through nutrient artery, which enters the bone via nutrient foramen. The present study aims to identify morphological and morphometric variations of nutrient foramina of the femur, which is the largest long bone of the body extending from the pelvis to knee. A sample of 81 Sri Lankan adult femur were analyzed. The mean length of the femur analyzed was 436.93 mm and mean foramen index was 43.52. The majority of the bones had a single nutrient foramen. The predominant location of the nutrient foramen was on the posterior aspect of the bone in the middle third of the shaft according to the study. Majority of foramina were directed distally. The indices on nutrient foramen are important for procedures such as bone grafts and tumor resections, in managing trauma, orthopedic procedures and radiological interpretations.

RESUMEN: El suministro de sangre a la diáfisis de los huesos largos se realiza principalmente a través de la arteria nutricia, que ingresa al hueso a través del foramen nutricio diafisario. El presente estudio tiene como objetivo identificar las variaciones morfológicas y morfométricas del foramen nutricio del fémur, el hueso largo más grande del cuerpo que se extiende desde la pelvis hasta la rodilla. Se analizó una muestra de 81 fémures adultos de individuos de Sri Lanka. La longitud media de los fémures analizados fue de 436,93 mm y el índice de foramen medio fue de 43,52. La mayoría de los huesos tenían un solo foramen nutricio. Según el estudio, la ubicación predominante del foramen nutricio estaba en la cara posterior del hueso en el tercio medio del eje. La mayoría de los forámenes estaban dirigidos distalmente. Los índices sobre el foramen nutricio son importantes para procedimientos tales como injertos óseos y resecciones tumorales, en el manejo de traumatismos, procedimientos ortopédicos e interpretaciones radiológicas.

Variations Of The Nutrient Foramina In Dried Human Femur

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.

A Study Of Nutrient Foramina Of Dry Humerus In South Indian Population

Background: Nutrient foramen is an opening in the bone shaft which allows passage to the blood vessels of themedullary cavity of a bone for its nourishment and growth. Knowledge about precise location and direction ofthe nutrient artery of long bones is important during any surgical or orthopaedic procedures of limbs, such asbone grafts and microsurgical vascular bone transplantations. This study was carried to record the number,situation and position of nutrient foramina in humerus of adults in south Indian population.Materials and methods: The study was conducted on 85(Right-38, Left-47) humerii collected from AnatomyDepartment of Coimbatore Medical College, Coimbatore. Length of each humerus bone was measured with thehelp of osteometric board. With the help of hand lens bones were observed for the number, direction andlocation of nutrient foramen with respect to the surface and borders.Results: In the present study majority of humerus bones have single nutrient foramen(64.7%) and mainly locatedon the anteromedial surface(51.7%) followed by medial border (36.5%) especially in the middle one third (87.1%)of the humerus.Conclusion: This study may give precise knowledge about location and number of nutrient foramina which isimportant for orthopaedic surgeons during surgical procedures such as fracture repair, bone grafts andmicrosurgeries.

Morphometric And Morphological Study Of The Nutrient Foramina In Dry Human Humerus Bones Of Telangana Region

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.

An Osteological Study On Nutrient Foramina Of Human Dry Adult Ulna Bones

Background: Nutrient artery is the major source of blood supply to long bones. This artery enters the shaft of thelong bone through nutrient foramen. Vascular insults to the Ulna during fracture dislocation or during surgicalcorrection of fracture may result in delayed healing or non-union of fracture.Materials and Methods: The present study was undertaken on 100 dry adult ulna bones of unknown sex (50 eachof right and left sides) from Department of Anatomy, Gadag Institute of Medical Sciences, Gadag, Karnataka. Theulna bones were numbered using a marker pen. Using Hepburn’s osteometric board, length of the bone wasmeasured. The size and direction of the nutrient foramina was assessed using 19, 22 and 25 gauge hypodermicneedles.Results: Among the total 100 ulna studied, 86 had single nutrient foramina, 13 had two nutrient foramina and 1had three nutrient foramina. 59.13% of nutrient foramina were of medium sized and 20% were of large size.85.22% of nutrient foramina were located in upper third of shaft of ulna; 12.17% in middle third and 2.61% inlower third. 1% of NF were directed horizontally, 2% lower oblique and remaining upper oblique. No correlationcould be demonstrated between the length of ulna and number of nutrient foramina in the present study.Conclusion: The present study conducted on nutrient foramina of 100 dry adult ulna arrived at a conclusion thatmajority of nutrient foramina were located in the upper third of the shaft in anterior surface. The results of thepresent study are consistent with most similar studies. The knowledge of location, direction and number ofnutrient foramen on shaft of ulna is of utmost importance to the Orthopaedicians and Oncologists.

Evaluation of Nutrient Foramina of the Dry Adult Human Femur Bone of North Indian Population

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.

Morphometric Study Of The Nutrient Foramina In Dry Human Radius Bones Of Telangana Region

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

Microstructure Study of Normal Lunates with Micro-computed Tomography / 华中科技大学学报（医学）（英德文版）

In order to study the microstructure characteristics of normal lunate bones,eight fresh cadaver normal lunates were scanned with micro-computed tomography.High-resolution images of the micro-structure of normal lunates were obtained and we analyzed the nutrient foramina.Then nine regions of interest (ROI) were chosen in the central sagittal plane so that we could obtain the parameters of trabecular bones of ROIs.The distal lamellar-like compact structure had statistically significant differences when it was compared with the ROIs in the volar and dorsal ends of the distal cortex.The difference of diameter between the volar and dorsal foramina was significant (P＜0.05).However,there was no significant difference regarding the number.The trabecular bones of the volar and dorsal distal ends had lower intensity than those of the distal central subchondral bone plate.The diameters of the nutrient foramina on the volar cortex were larger than those on the dorsal.This research provided more detailed information about microstructure of normal lunate and the nutrient foramina on cortex,and a reference for further study about diseased lunate.

Morphological study of nutrient foramina of human radius and their clinical importance

Background: Radius is the lateral bone of forearm. It has anterior, interosseus and posterior surface. Anterior surface bears a nutrient canal at the upper end transmitting nutrient artery. Nutrient artery is the major source of blood supply of long bones mainly during growing period and early phase of ossification. Aim and objectives: Nutrient foramina is essential for nutrition and growth for long bones and also for survival of osteocytes in some procedures such as bone graft, tumor resection, congenital pseudoarthrosis, trauma and transplant techniques in orthopaedics. Study of nutrient foramina is important not only in academic purpose but also useful in medico-legal cases in relation to their position. Materials and methods: Present study was conducted in the department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar. 110 dry adult and macerated human radii were selected for study. Results: In this study, out of 110 radii, 108 radii had single foramina and 2 radii had double nutrient foramina. Foraminal index was calculated which indicating nutrient foramina was near to the upper end. Conclusion: Nutrient foramen in radius was near to the upper end, so the lower end of radius is the growing end.

Study of Nutrient Foramina of Adult Femora With its Correlation to Length of the Bone.

Introduction: Femur is the most richly vascularised long bone which derives its nourishment from various arteries of the lower limb. The quantum of blood supply is determined by the number and calibre of these arteries. Shaft of this bone is supplied by the vessels from perforators of the thigh which gives nutrient branches to it. Femoral shaft fractures are severe disabling injuries that demand critical evaluation as to the method of treatment. Since the success of these operations depends on a minimal interference with the blood supply of the bone, the knowledge of anatomy of the nutrient vessels is of considerable importance. Materials and Methods: The study was conducted on 300 adult femora available in the department of Anatomy. The study was undertaken to collect information on the variations in number, location, size of the nutrient foramina and if correlation exists between the length of femur and number of nutrient foramina. Results: 60% of the bones had double, 39.33% had single and only 0.67% had single nutrient foramina (NF). 52% of them were on medial lip of linea aspera followed by 41%on lateral lip and the rest scattered. 80% of NF was located on upper and middle segments of shaft and very meagre number in lower segment. No correlation was noted between number of NF and length of the bone. Discussion and Conclusions: The findings in the present study are compared and analyzed with previous researchers. The magnitude of care to be imparted while dealing with fractures of femoral shaft is discussed. The detailed knowledge on vascular anatomy of shaft would allow surgeon to preserve them during procedures.

Study of Diaphyseal Dominant and Secondary Nutrient Foramina in Fibula: its Clinical Relevance in Vascular Bone Graft Surgery.

Background: The external opening of the nutrient canal, usually referred to as the nutrient foramen has a particular position in each bone. An understanding of the position and number of the nutrient foramina in fibula is important, as this is one of the most common bones used in bone grafts, vascularized bone microsurgery and mandibular reconstruction. Nowadays fibula flap is the most accepted flaps used in the mandibular reconstruction especially in the malignancy of oral and oropharyngeal regions. Materials and Methods: The present study was conducted in 160 dry human fibula obtained from department of Anatomy, N.S.C.B. Medical college Jabalpur {M.P.}. We have measured the different parameters in each bone according to standard method. Result: In our study we found that 95% bones possess single dominant nutrient foramina. According to Foraminal Index (FI), the position of most of foramina [97%] was fall in Type 2 (middle third of the fibula). The mean foraminal index (FI) was 39.66±5.29. The average total length (TL) of fibula was 35.80±2.53. Conclusion: To conclude that our study provides detailed data about the position and number of nutrient foramina of fibula that is considered as a determining factor for the success of new techniques for bone transplant and resection in orthopaedics.

Morphometric Analysis of Nutrient Foramina in Human Typical Long Bones Of Upper Limb.

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.

Morphological Variations of Nutrient Foramina in upper limb long bones.

The nutrient artery is the principal source of blood supply to a long bone and is particularly important during its active growth period in the embryo and foetus as well as during the early phase of ossification. The aim of the present study was to study the topographic anatomy and morphology of the nutrient foramina in human adult upper limb long bones. The study was performed on 40 upper limb long bones which include 40 humerii, 40 radii, 40 ulnae. The bones were obtained from department of anatomy Punjab institute of medical sciences, Jalandhar. The variations were found in number and location of nutrient foramen in different upper limb bones. In humerus double and triple foramina were found. In radius and ulna double foramina were observed at the maximum. Absence of nutrient foramen was observed in radius. The knowledge about these foramina is useful in surgical procedures.

Nutrient Foramina in the Upper and Lower Limb Long Bones: Morphometric Study in Bones of Southern Brazilian Adults / Forámenes Nutricios en los Huesos Largos de los Miembros Superiores e Inferiores: Estudio Morfométrico en Huesos de Adultos del Sur de Brasil

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 orthopedics. The present study analyzed the location and the number of nutrient foramina in the diaphysis of 885 long bones of the upper and lower limbs of adults: 174 humeri, 157 radii, 146 ulnae, 152 femora, 142 tibiae and 114 fibulae. The location of the nutrient foramina is predominant on the anterior aspect of the upper limb long bones, and on the posterior aspect of the lower 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 55.2 percent for the humerus, 35.7 percent for the radius, and 37.9 percent for the ulna, and for the lower limb bones, 43.7 percent for the femur, 32.7 percent for the tibia and 46.1 percent for the fibula. This study recorded data related to the population of Southern Brazil, providing ethnic data to be used for comparison and that may help in surgical procedures and in the interpretation of radiological images.

El importante aporte de sangre para los huesos largos se produce a través de las arterias nutricias, que penetran por los forámenes nutricios. Este suministro es esencial durante el período de crecimiento, las primeras fases de osificación y en los procedimientos como injertos óseos, resecciones tumorales, traumas, pseudoartrosis congénita y en las técnicas de trasplante en ortopedia. El estudio determina la ubicación y el número de forámenes nutricios en las diáfisis de 885 huesos largos de los miembros superiores e inferiores pertenecientes a individuos adultos. Fueron estudiados 174 húmeros, 157 radios, 146 ulnas, 152 fémures, 142 tibias y 114 fíbulas. La ubicación de los forámenes nutricios era predominante en la parte anterior de la diáfisis de los huesos largos del miembro superior y en la parte posterior de los huesos largos del miembro inferior. La mayoría de los huesos estudiados tenía un solo foramen nutricio, representando una sola fuente de suministro de sangre. El índice medio foraminal en los huesos del miembro superior fue de 55,2 por ciento para el húmero, 35,7 por ciento para el radio, y 37,9 por ciento para el ulna; en los huesos del miembro inferior fue 43,7 por ciento para el fémur, 32,7 por ciento para la tibia y 46,1 por ciento para la fíbula. Este estudio registró datos relativos a la población del Sur de Brasil, proporcionando antecedentes étnicos que además puedan servir de ayuda en los procedimientos quirúrgicos y en la interpretación de imágenes radiológicas.

Diaphysial nutrient foramina in long bones and miniature long bones.

Background: Nutient foramen is an opening into the bone shaft which gives passage to the blood vessels of the medullary cavity of a bone. The knowledge of nutrient foramen is important in surgical procedures like bone grafting and more recently in microsurgical vascularised bone transplantation. Aim: to determine the number, direction, position of nutrient foramen and whether the nutrient foramina obey the general rule that is, directed away from the growing end of the bone. Materials and methods: The present study has been undertaken to review 1000 long bones including clavicle and miniature long bones. Results 6.8% of bones showed no foramen while 10% of bones had double foramen. Conclusion: Majority of the bones followed the growing end theory. Clavicle showed more variation as to the surface on which nutrient foramen was present. None of the earlier workers have done compiled study of all types of long bones in a single study.

A study of the nutrient foramina of the humeral diaphysis.

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.