Observations on the nutrient foramina of the human radius and ulna

Morphometric, morphologic and topographic evaluation of diaphyseal nutrient foramina of the femur

PURPOSE

Vascularization of bones is crucial for bone growth and repair. The nutrient artery, passing through the nutrient foramen, is key to bone blood supply, but its impact on fracture healing and complications is not fully understood. The study aims to investigate the morphology and location of the nutrient foramen in the femoral diaphysis and to understand its clinical implications for fractures.

METHODS

In this study, 88 adult dry femurs of unknown age and sex were examined. The characteristics of the nutrient foramina, including number, size, direction, and localization were evaluated. The foraminal index [(distance from foramen to proximal end of femur/total length of femur) × 100], was employed to categorize the regions [Region-I, 0-33.33; Region-II, 33.34-66.66; Region-III 66.67-100].

RESULTS

The majority of the femurs had one or two foramina (92.94%). Of the total number of nutrient foramina, 121 (97.58%) were directed towards the proximal end, while three (2.42%) were horizontal. The majority of foramina were detected in sizes 18G (34.67%) and 20G (27.42%). All nutrient foramina were found on the posterior surface of the femur and adjacent to linea aspera. Sixteen nutrient foramina were located (12.90%) in Region-I, 104 (83.87%) in Region-II, and 4 (3.23%) in Region-III.

CONCLUSIONS

The nutrient foramina were typically located in the middle third of femur, adjacent to linea aspera on the posterior surface of femur. This observation indicates that the anterior surface is safer for surgery, while caution is needed near the linea aspera on the posterior surface.

Scapular foramina - a systematic review with meta-analysis based on 3316 scapulae

PURPOSE

In the present study, we want to systematize the previous studies on the scapular foramina (SF) and nutrient foramina (NF) with emphasis on the clinical relevance of this topic. Although seemingly not important, radiologists, clinicians and surgeons should be aware of the presence and characteristics of the SF and NF and look out for possible mistakes that may cause harm to the patients during either the diagnostic process or surgery.

METHODS

A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Web of Science, Embase, Cochrane Library and Google Scholar. The whole process was divided into three stages. In the first stage, the following search terms were used: ((scapular foramina) or (scapular foramen) or (scapular nutrient foramina) or (scapular nutrient foramen) or (scapula foramen) or (scapula foramina) or (scapula nutrient foramina)).

RESULTS

The results of the present meta-analysis were based on a total of 3316 studied scapulae. A pooled prevalence of scapulae in which at least one SF was found was set to be 11.29%. The most common localization of the SF was found to be the infraspinous fossa, in which the SF occurred with the prevalence of 52.31%. Subsequently, a pooled prevalence of scapulae in which at least one NF occurs was established at 74.23%.

CONCLUSION

The presented data contribute to a comprehensive understanding of the prevalence, distribution, and characteristics of suprascapular and nutrient foramina in scapulae, considering different topographical areas, genders, and sides.

3D Mapping of Bone Channel of Blood Supply to Femoral Head in Proximal Femur

Background

A detailed depiction of nutrient foramina is useful for defining guidelines and minimising iatrogenic damage during hip surgery. Therefore, this study aimed to define the location and frequency of nutrient foramina in the proximal femur using mapping techniques.

Methods

One hundred dry human cadaveric proximal femurs, comprising 56 left and 44 right femurs, were scanned using a three-dimensional scanner, with scanning distance 200 mm, precision 0.01 mm, and measuring point 0.04 mm. The image resolution of 1,310,000 pixels was obtained. Digital imaging models were acquired from the proximal femur surface. All the nutrient foramina in each model were identified and marked. The nutrient foramina models were superimposed on one another and oriented to fit a standard template of the femur’s proximal aspect. Three-dimensional mapping in the proximal femur’s nutrient foramina was performed.

Results

The nutrient foramina’s location and dense zones were identified. The dense zones were distributed along the vascular course and gaps between the muscle attachment sites. Eighteen dense zones were identified and found to be location-dependent. They were located in the central part of the fovea capitis femoris, subcapital and basicervical areas of the femoral neck, and muscle attachment gaps of the femoral trochanter.

Conclusions

The terminal branch of the nutrient vessels entering the nutrient foramina is at risk for iatrogenic damage during hip surgeries, especially in cases of close bone exposures. There are 18 dense zones that need to be considered for a safer approach to the proximal femur. To minimise iatrogenic damage to the nutrient vessels entering the nutrient foramina, the dense areas should be avoided when technically possible.

Diaphyseal nutrient foramina in the humerus, radius, femur, and tibia bones of mixed breed dogs

Objective:

The objective of this study was to determine the location, number, and direction of the nutrient foramen in the humerus, radius, femur, and tibia bones of mixed breed dogs.

Materials and Methods:

The humerus, radius, femur, and tibia of both (left and right) limbs of mixed breed dogs were examined in this study. The number, location, and direction of the nutrient foramina were identified. Once identified, the diameter of each nutrient foramen was measured and the site index calculated.

Results:

Only one nutrient foramen was identified in the humerus, radius, tibia, and right femur, while the foramen numbers ranged from one to three in the left femurs examinated. The nutrient foramen was localized on the caudal surface in the radii, femurs, tibias, and left humeri. Contrasting, however, 75% were located on the caudal surface of the right humeri and 25% on the lateral surface. The average diameter of the nutrient foramen of the humerus ranged from 0.88 to 1.00 mm, while it ranged from 1.13 to 1.25 mm in the radius. On the hind limb, the diameter of the nutrient foramen on the femur ranged from 1.2 to 1.3 mm and 0.75–1.25 mm on the tibia. The nutrient foramen was directed towards the corresponding joint in 100% of the humeri and tibias, 75% of the radii, and 60%–80% of the femurs examined.

Conclusion:

The anatomical data on the nutrient foramen obtained in this study will be valuable for veterinarians when diagnosing pathological bone lesions and for orthopedic surgery.

Three-dimensional topography of scapular nutrient foramina

Purpose

The aim of this study is to describe the number and location of the nutrient foramina in human scapulae which can minimize blood loss during surgery.

Methods

30 cadaveric scapulae were macerated to denude the skeletal tissue. The nutrient foramina of 0.51 mm and larger were identified and labeled by adhering glass beads. CT scans of these scapulae were segmented resulting in a surface model of each scapula and the location of the labeled nutrient foramina. All scapulae were scaled to the same size projecting the nutrient foramina onto one representative scapular model.

Results

Average number of nutrient foramina per scapula was 5.3 (0–10). The most common location was in the supraspinous fossa (29.7%). On the costal surface of the scapula, most nutrient foramina were found directly inferior to the suprascapular notch. On the posterior surface, the nutrient foramina were identified under the spine of the scapula in a somewhat similar fashion as those on the costal surface. Nutrient foramina were least present in the peri-glenoid area.

Conclusion

Ninety percent of scapulae have more than one nutrient foramen. They are located in specific areas, on both the posterior and costal surface.

Plating the radial shaft on the lateral surface: An outcome study

PURPOSE

Plate fixation is the gold standard for the treatment of displaced forearm shaft fractures in adults. Conventionally radial shaft fractures will be plated either on the volar surface or on the dorsal surface depending on which approach has been chosen. The lateral surface of the radius provides an even and uniformly curved area for placing a plate. It has the advantage of restoring and easy assessing the radial bow after surgery. We designed a prospective study to observe the outcome of lateral plating of radius shaft fractures.

METHODS

Nineteen patients were included in this study performed in Government Medical College, Jammu, India. Among them, 13 had fractures of both the forearm bones and 6 had isolated radial shaft fracture. Three patients had Galeazzi fracture dislocation. Fixation was done within 36 h of injury in all using 3.5 mm limited contact dynamic compression plate or locking compression plate applied to the lateral surface of the radius. Ulna was fixed in routine manner.

RESULTS

Union was achieved in 18 out of 19 patients, after a mean time of 17.44 weeks. According to Anderson et al.'s criteria, 12 patients had excellent results, 5 had satisfactory and 1 had unsatisfactory result. There was one failure (nonunion).

CONCLUSION

The outcomes including rate of union were comparable to those in the existing literature. Plating the radial shaft on the lateral surface is a viable alternative to volar or dorsal plating of the radius. Larger studies with randomized data are needed to assess whether it has any superiority over other existing techniques.

Sex estimation using dimensions around the nutrient foramen of the long bones of the arm and forearm in South Africans

South Africa has had an increase in rates of crime, interpersonal violence and homicide since the introduction of democracy in 1994. Forensic osteological standards was lacking for South Africans of different population groups necessitating the generation of new standards for forensic identification of individuals from skeletal remains. For these reasons, there is a concerted demand for methods of identifying skeletal remains with sex being amongst the most important of the biological characteristics required. The nutrient foramen has been used to estimate sex in lower limb long bones with much accuracy but this has not been demonstrated in the upper limb long bones. The aim of this study was to develop osteometric standards for sex estimation from measurements around the nutrient foramen of the arm and forearm bones of South Africans of different population affinities. A total of 660 bones consisting of humeri, radii and ulnae of black South Africans and white South Africans were assessed for sex estimation using dimensions related to the nutrient foramen. Sex was correctly classified with a range of 84-85% for the humerus and 83-88% for the arm bones. The study showed that length measurements were more sexually dimorphic than width dimensions in South Africans, as length was consistently selected as the best predictor of sex in all bones. However, the average accuracy increased when length was used in combination with measurements related to the nutrient foramen. In conclusion, the dimensions of upper limb long bones that are directly related to the nutrient foramen are sexually dimorphic and are useful in the estimation of sex in South Africans, with the highest accuracy shown in the white South African population group.

An Anatomical Study of the Nutrient Foramina of the Human Humeral Diaphysis

Background

Understanding the nutrient foramina is critical to clinical practice. An insult to the nutrient foramina can be caused by trauma and/or surgical dissection and lead to devascularization and bad outcomes. Few studies have looked at the humerus, and no studies have described relative information of humeral nutrient foramen related to anatomical structures that might be located by palpable landmarks. In this study, we analyzed the anatomical features of the nutrient foramina of the diaphyseal humerus and provide a discussion of clinical relevance.

Material/Methods

We dissected 19 cadavers and analyzed the relative positions of the foramina and surrounding muscles, and the number, direction, diameter, and location of the nutrient foramina. Foramina index and a new landmark index were used to calculate the location. We compared the data from both sides and the relationships between transverse and longitudinal locations, diameter and total length, and foramina index and landmark index were also analyzed.

Results

The humeri had one or two main nutrient foramina located in a small area between the coracobrachialis and brachial muscles and oriented toward the elbow. The mean diameter was 1.11±0.32 mm. The mean index and landmark index were 43.76±4.94% and 42.26±5.35%, respectively. There were no differences between sides in terms of diameter, length, or nutrient foramina index. There were no significant correlations between transverse and longitudinal locations or diameter and total length. The foramina index and landmark index showed strong positive correlation (r=0.994, p<0.0001).

Conclusions

Our study provides details about the nutrient foramina that will benefit clinicians who treat injuries and diseases of the humerus. Surgeons should be mindful of soft tissue in the foraminal area during surgical procedures.

Location, number and clinical significance of nutrient foramina in human long bones

Nutrient arteries, the main blood supply to long bones, are particularly important during the active growth period, as well as during the early phases of ossification. In the present study, 569 adult human long bones of the upper (101 humeri, 93 radii, 102 ulnae) and lower (100 femora, 100 tibiae, 73 fibulae) limbs were investigated to determine the number and location of their nutrient foramina. For each bone, a foraminal index was calculated giving the location of the nutrient foramen in relation to its proximal end. In the upper limb, foramina were located on the diaphysis 15-69% of the overall length of the humerus, 22-46% for the radius and 27-54% for the ulna. In the lower limb, foramina were located on the diaphysis 29-69% of the overall length of the femur, 27-63% for the tibia and 26-83% for the fibula. In addition, the number and the distribution of the foramina in relation to specific regions/surfaces of the diaphysis were identified. This study provides additional and important information on the location and number of nutrient foramina in the long bones of the upper and lower limbs in the Turkish Caucasian population.

The effect of an extended flexor carpi radialis approach on blood flow to the distal radius: a cadaveric study

The effect of an extended flexor carpi radialis approach on the blood supply of the radius was examined in six (3 paired) fresh frozen cadaver limbs after injection with India ink and clearing using a modified Spalteholz technique. An extended flexor carpi radialis approach to the distal radius was made in the left limb in each of the three-paired limbs. The right limb served as a nonoperative control. Following perfusion of the arterial vasculature of each limb with India ink, serial transverse sections were cut and the intraosseous blood supply evaluated using a modified Spalteholz technique. Both controls and surgical specimens demonstrated complete cortical penetration from endosteal vessels in the proximal and midsections of the radius. In the distal radius, surgical specimens demonstrated reduced perfusion volarly, however there continued to be perfusion of ink through intact dorsal and ulnar metaphyseal perforating arteries. Persistent vascular perfusion to the distal radius remains through intact endosteal vessels and metaphyseal perforators of extensive surgical soft-tissue stripping.

Vascular anatomy of the ulna

The vascular anatomy of the ulna was studied. Ten fresh-frozen upper extremity specimens were injected with India ink and latex solution. The extraosseous anatomy was dissected. The intraosseous anatomy was evaluated after treatment with the modified Spalteholtz technique. The proximal periarticular portion of the ulna was supplied by numerous, very small periarticular branches running in the capsule. A major intramedullary nutrient vessel arose from the ulnar artery or ulnar recurrent artery in all specimens and entered at the base of the coronoid. The ulnar artery gave off a common interosseous artery that branches into posterior and anterior interosseous vessels that course distally on the interosseous membrane. The interosseous vessels were critical for they supply the only observed vascular branches to the ulna diaphysis. The anterior interosseous vessel supplied on average 7 branches (range, 3-11 branches) to the ulna diaphysis spaced at generally regular 2-cm intervals, with the number of branches decreasing in the distal third. The posterior interosseous artery supplied an average of 11 branches (range, 9-14 branches) to the ulna diaphysis spaced at 1-cm intervals. The distal ulna metaphysis was supplied by terminal branches of the anterior interosseous artery. The ulnar head was supplied by small branches off the ulnar artery proper. In summary, the blood supply to the ulna diaphysis was dependent on segmental vessels provided by the anterior and posterior interosseous vessels. No dominant intramedullary vessel was observed in the diaphysis. The interosseous vessels should be protected when treating a ulna fracture or a nonunion, or when performing an osteotomy.

Arterial supply of forearm bones and its importance for the operative treatment of fractures

The operative exposure of a fracture in an osteosynthesis causes disturbances in the blood supply, which often leads to a prolonged process of healing or even to healing problems, a fracture non-union, which is frequently located at the forearm. In order to damage the supplying vessels as little as possible, the position, direction and penetration of the arteries of radius and ulna are demonstrated and systematised in this study. Near the elbow arteries, coming from large adjoining vessels, penetrate the area of the capsular insertion. The nutrient arteries enter both bones in the second proximal quarter of diaphysis, at the radius from anterior to medial, at the ulna from anterior to anteroradial. Small vessels, which penetrate closely proximal to the articular surface in order to supply the distal forearm bones, come from an anastomosis between the radial, the interosseous and the ulnar arteries. In this study access vessels, choice and position of implants will be discussed.

Nutrient foramina in the shafts of lower limb long bones: situation and number

The location and number of the diaphysial dominant nutrient foramina in 305 specimens of the human lower limb long bones were examined. The diaphysial nutrient foramina on the femur were located at between 26.7-84.4% of the total length; while on the tibia between 11.0-67.2%; and on the fibula between 29.8-67.8% of the total length. The number of the diaphysial nutrient foramina and their distribution on the faces of each bone was also studied.

A study of the nutrient foramina in human long bones

The present study analyzed the location and number of the diaphysial nutrient foramina in six long bones of adult human skeletons of unknown age and sex from a statistical view point. The diaphysial nutrient foramina in the humerus, are located at between 50 and 65% of the total length; in the radius and ulna, at between 25 and 50%; in the femur, at between 25 and 58%; in the tibia, at between 30 and 40%; and in the fibula at between 35 and 67%, i.e. the middle third of the bone. Also studied were the anatomical position and number of the diaphysial nutrient foramina in each bone.