Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis

Abstract Background A defective nutrient foramen in the fovea capitis femoris was hypothesized to reflect the blood circulation pattern of the femoral head, leading to insufficient blood supply and causing osteonecrosis of the femoral head. Methods Normal and necrotic femoral head specimens were collected. The necrotic femoral head group was divided into a non-traumatic and traumatic subgroup. 3D scanning was applied to read the number, the diameter, and the total cross-sectional area of the nutrient foramina in the fovea capitis femoris. Chi-squared tests and independent t-tests were used to detect any differences in the categorical and continuous demographic variables. Logistic regression models were used to estimate the odds ratio (OR) for non-traumatic and traumatic osteonecrosis in different characteristic comparisons. Results A total of 249 femoral head specimens were collected, including 100 normal femoral heads and 149 necrotic femoral heads. The necrotic femoral head group revealed a significantly higher percentage of no nutrient foramen (p < 0.001), a smaller total area of nutrient foramina (p < 0.001), a smaller mean area of nutrient foramina (p = 0.014), a lower maximum diameter of the nutrient foramen (p < 0.001), and a lower minimum diameter of the nutrient foramen (p < 0.001) than the normal femoral head group. The logistic regression model demonstrated an increasing number of nutrient foramina (crude OR, 0.51; p < 0.001), a larger total area of nutrient foramina (crude OR, 0.58; p < 0.001), a larger mean area of nutrient foramina (crude OR, 0.52; p = 0.023), a greater maximum diameter of the nutrient foramen (crude OR, 0.26; p < 0.001), and greater minimum diameter of the nutrient foramen (crude OR, 0.20; p < 0.001) significantly associated with reduced odds of osteonecrosis of the femoral head (ONFH). The necrotic femoral head group was further divided into 118 non-traumatic and 31 traumatic necrotic subgroups, and no significant difference was observed in any characteristics between them. Conclusions Characteristics of the nutrient foramen in the fovea capitis femoris showed a significant defect of necrotic than normal femoral heads, and significantly reduced odds were associated with the higher abundance of the nutrient foramen in ONFH. Therefore, the condition of the nutrient foramen might be the indicator of ONFH.

Download Full-text

Atraumatic femoral head necrosis: a biomechanical, histological and radiological examination compared to primary hip osteoarthritis

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03890-4 ◽

2021 ◽

Author(s):

Hofmann Alexander ◽

Fischer Benjamin ◽

Schleifenbaum Stefan ◽

Kurz Sascha ◽

Edel Melanie ◽

...

Keyword(s):

Bone Density ◽

Femoral Head ◽

Hip Osteoarthritis ◽

Head Group ◽

Common Disease ◽

Stress Tests ◽

Value Analysis ◽

Femoral Neck Axis ◽

Significant Difference ◽

Femoral Heads

Abstract Introduction Atraumatic necrosis of the femoral head (AFHN) is a common disease with an incidence of 5000–7000 middle-aged adults in Germany. There is no uniform consensus in the literature regarding the configuration of the bone in AFHN. The clinical picture of our patients varies from very hard bone, especially in idiopathic findings, and rather soft bone in cortisone-induced necrosis. A better understanding of the underlying process could be decisive for establishing a morphology-dependent approach. The aim of this study is the closer examination of the condition of the bone in the AFHN compared to the primary hip osteo arthritis (PHOA). Materials and methods The preparations were obtained as part of elective endoprosthetic treatment of the hip joint. Immediately after sample collection, thin-slice CT of the preserved femoral heads was performed to determine the exact density of the bone in the necrosis zone. Reconstruction was done in 0.8–1 mm layers in two directions, coronary and axial, starting from the femoral neck axis. Density of the femoral heads was determined by grey value analysis. The value in Hounsfield units per sample head was averaged from three individual measurements to minimize fluctuations. For biomechanical and histomorphological evaluation, the samples were extracted in the load bearing zone perpendicular to the surface of the femoral head. Group-dependent statistical evaluation was performed using single factor variance analysis (ANOVA). Results A total of 41 patients with a mean age of 64.44 years were included. The mean bone density of the AFHN samples, at 1.432 g/cm3, was about 7% higher than in the PHOA group with a mean value of 1.350 g/cm3 (p = 0.040). The biomechanical testing in the AFHN group showed a 22% higher—but not significant—mean compressive strength (20.397 MPa) than in the PHOA group (16.733 MPa). On the basis of histological analysis, no differentiation between AFHN and PHOA samples was possible. Conclusions The present study (NCT, evidence level II) shows that AFHN has a very well detectable higher bone density compared to PHOA. However, neither biomechanical stress tests nor histomorphological evaluation did show any significant difference between the groups. The results allow the conclusion that there is no “soft” necrosis at all in the AFHN group.

Download Full-text

NUTRIENT FORAMEN;

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.08.76 ◽

2018 ◽

Vol 25 (08) ◽

pp. 1252-1255

Author(s):

Anwaar Hussain ◽

Jawaria Khalid ◽

Abdul Rauf

Keyword(s):

Blood Supply ◽

Bone Grafting ◽

Posterior Surface ◽

Anterior Surface ◽

Cross Sectional ◽

Nutrient Foramen ◽

Nutrient Foramina ◽

Clinical Interest ◽

The Mean ◽

Medical University

Objectives: To study the nutrient foramina of the dried human clavicle with respectto their position, number and direction for clinical interest. Study Design: Cross sectional study.Setting: Anatomy Department Faisalabad Medical University Faisalabad. Period: Six monthsfrom July to December 2017. Material and Methods: 60 dried human clavicles taken frombone bank of Anatomy Department Faisalabad Medical University Faisalabad. The foraminawere studied according to their location, and number and direction. The foramina index wascalculated using Hughes Formula by measuring the average total length and average lengthof foramina from sternal end of the clavicle. Results: The nutrient foramen was observed in all60(100%) of the clavicle. Single foramen was present in 22 (36.6%) clavicle and double foramenin 30(50%) clavicle. Triple and quadruple foramen in 6(10%) and 2(3.3%) clavicles respectively.The 34 left clavicles posses single foramen 12 (41.1%), double foramen 14(35.2%) while tripleand quadruple are 6(17.6%) and 2(5.8%) respectively. Total 26 right clavicles had 10 (38.4%)single foramen and 16(61.5%) double foramen. Total number of foramen in all 60 clavicleswere 108 of which 61.1% are located on posterior surface of the clavicle, 27% were found oninferior surface and rest 11.1% were on anterior surface. The clavicle having more than oneforamina are 28 out of which 64.2% was having both inferior and posterior foramina, 21.4 % wasanterior and posterior while 14.28% was located on triple sites anterior, inferior and posterior.We also found 90% of foramina were present on middle 1/3 and 10% on lateral 1/3. 98.3% ofthe foramina were directed to acromial end while rest 1.7 % to sternal end. The mean length offoramina from sternal end is 7.46 cm and mean maximum length of the clavicle was 14.51cm.The mean foramina index was 51.41. Conclusion: It is concluded from the study that most ofthe foramina are located on middle 3rd of the clavicle the commonest site of the fractures of thebone. Most of the foramina are located on the posterior surface denoting its blood supply fromthe neighboring blood supply. The knowledge of the foramina and its blood supply is importantfor fracture healing and bone grafting.

Download Full-text

Heat Generation and Dissipation Behavior of Various Orthopaedic Bearing Materials

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.309-311.1281 ◽

2006 ◽

Vol 309-311 ◽

pp. 1281-1284 ◽

Cited By ~ 1

Author(s):

Stanley Tsai ◽

Abraham Salehi ◽

Patrick Aldinger ◽

Gordon Hunter

Keyword(s):

Femoral Head ◽

Peak Load ◽

Tetragonal Zirconia ◽

Ultrahigh Molecular Weight Polyethylene ◽

Interface Surface ◽

Hip Simulator ◽

Significant Difference ◽

Femoral Heads ◽

Oxidized Zirconium ◽

Bearing Materials

It has been shown that with high interfacial temperatures in hip bearings, it is possible to precipitate proteins, greatly reduce the compressive creep properties of ultrahigh molecular weight polyethylene (UHMWPE), and change the phase content of monolithic tetragonal zirconia. These induced features may alter the wear rate of UHMWPE. It was the objective of this study to examine the interfacial temperatures of oxidized zirconium (OxZr) heads as compared with metallic and ceramic heads coupled with polyethylene in a hip simulator. The interface temperatures were measured by placing thermocouples within 0.5 mm of the interface surface of both femoral heads and acetabular liners, and then articulating the surfaces using a 12-station AMTI anatomic hip simulator. The alumina femoral heads had the lowest average interfacial temperature, followed in increasing order by OxZr, CoCr, and zirconia. The ranking corresponds to the thermal conductivity of each material. A statistically significant difference (p<0.05) was found between all four materials for the femoral head temperature. No difference was seen in liner temperature between the alumina and OxZr groups, but statistical differences were found between all other combinations. Additionally, increasing head diameter, peak load, cyclic frequency, and serum concentration all resulted in statistically significant increases in both femoral head and liner temperatures.

Download Full-text

Study of Nutrient Foramina in Human Typical Long Bones of Lower Limb

National Journal of Clinical Anatomy ◽

10.1055/s-0039-1688547 ◽

2019 ◽

Vol 08 (02) ◽

pp. 077-081 ◽

Cited By ~ 1

Author(s):

Ajay Parmar ◽

Pankaj Maheria ◽

Kanan Shah

Keyword(s):

Blood Supply ◽

Lower Limb ◽

Fracture Repair ◽

Lower Limbs ◽

Long Bones ◽

Posterior Aspect ◽

Nutrient Foramen ◽

Nutrient Artery ◽

Nutrient Foramina ◽

The Right

Abstract Background and Aim Nutrient foramina form important landmarks on human bones as they form portal of entry for nutrient artery. Nutrient artery is an important source of blood supply for a growing bone. Different parameters of nutrient foramina are important in various procedures such as vascularized bone grafting, tumor resections, fracture repair, and other surgical procedures in orthopedics. The objective of the present study was to report the number, position, direction, size, and foraminal index of nutrient foramen in the femur, tibia, and fibula. Materials and Methods The present study analyzed the location, direction, size, and the number of nutrient foramina in the diaphysis of 180 long bones of the lower limbs of adults: 60 femurs, 60 tibiae, and 60 fibulae. Result The location of the nutrient foramina is predominant on the posterior aspect of the lower limb long bones. Single nutrient foramen found in the tibia (100%), femur (48.3%), and fibula (60%) may represent as a single source of blood supply. The majority of the femur (50%) and few fibulae (5%) had a double nutrient foramen. The mean foraminal index for the lower limb bones was 40.5% for the left and 38.2% for the right side of the femur, 31.69% for the left and 32.3% for the right side of the tibia, and 32.7% for the left and 31.7% for the right side of the fibula. Conclusion The present study provides information on the number, size, position, and direction of nutrient foramina of the femur, tibia, and fibula bones.

Download Full-text

Morphometric Evaluation of Dry Humerus Bone in a Medical College of Eastern Nepal

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i2.25455 ◽

2019 ◽

Vol 4 (2) ◽

pp. 729-733

Author(s):

Raju Kumar Chaudhary ◽

Arun Dhakal ◽

Sanjib Kumar Sah ◽

Surya B Prajuli ◽

Suman Pokhrel ◽

...

Keyword(s):

Teaching Hospital ◽

Articular Surface ◽

Anthropometric Measurement ◽

Transverse Diameter ◽

Morphometric Measurements ◽

Statistical Significant Difference ◽

Nutrient Foramen ◽

Medical College ◽

Nutrient Foramina ◽

Significant Difference

Introduction: Anthropometric measurement of dry bones are helpful to estimate the stature. It is useful for differentiating unidentified bodies, skeletal remains, surgical procedures and are helpful for anthropologists, anatomists, forensic and surgery. Objective: The objective of this study was to find the morphometric measurements of dry Humerus bone available at Birat Medical College and Teaching Hospital of Eastern Nepal. Methodology: A cross- sectional study was conducted from 28th June- 28th July 2019 in the department of Anatomy of Birat Medical College and Teaching Hospital by taking 59 dry humerus bone. Various parameters such as maximum length, circumference of surgical neck, epicondylar breadth together with position and number of nutrient foramina were measured. Data was collected using osteometric board, vernier caliper and tape. The number, direction and location of nutrient foramina were observed macroscopically by using a fine wire. Ethical clearance was taken from Institutional Review Committee of Birat Medical College and Teaching Hospital. Results: Among 59 dry humerus bone, majority (32) were left humerus. No statistical significant difference was found in morphometric measurements between right and left side of dry Humerus bone. The single nutrient foramen was present in 85.18% and 81.25% of right and left humeri respectively. Double nutrient foramina in 14.81% of right humeri and 15.62% of left humeri. Triple nutrient foramina was only seen in left humeri (3.12%). Conclusion: Single nutrient foramen is most common in both sides of humeri. No statistical significant difference was found between right and left humeri in the different parameters such as maximum humeral length (MHL), vertical diameter of superior articular surface (VDSAS), circumference of surgical neck (CSN), circumferences of middle shaft (CMS), epicondylar breath (EB), medial epicondyle to capitulum (ME - C), transverse diameter inferior articular surface (TDIAS), maximum transverse diameter of trochlea (MTDT), anteroposterior diameter of the trochlea (APDT) and position of nutrient foramina (PNF).

Download Full-text

Morphometrical and Topographical Anatomy of Position of Nutrient Foramen on Fully Ossified Left Femur

Delta Medical College Journal ◽

10.3329/dmcj.v1i1.14970 ◽

2013 ◽

Vol 1 (1) ◽

pp. 13-15

Author(s):

Md Shahajahan Chowdhury ◽

Humaira Naushaba ◽

Jahanara Begum ◽

Shameem Ahmed ◽

Laila Farjana Khan ◽

...

Keyword(s):

Blood Supply ◽

Sampling Technique ◽

Cross Sectional Study ◽

Long Bone ◽

Cross Sectional ◽

Left Femur ◽

Nutrient Foramen ◽

Medical College ◽

Growing Period ◽

Nutrient Foramina

Background: The femur is the typical long bone of lower limb which extends from the pelvis to the knee. It forms the skeleton of the thigh, bears body weight, supports movement of legs; provide attachment to muscles, form blood cells and acts as a store house for calcium and phosphate. The nutrient foramina are cavities that conduct the nutrient arteries and the peripheral nerves. The majority blood supply for femur originates from the nutrient arteries, mainly during the growing period and during the early phase of ossification. In bone grafts the nutrient blood supply is crucial and it should be preserved in order to promote the fracture healing. Objective: The anatomy of nutrient foramen of femur is very essential for orthopedic & vascular surgeons as well as to radiologists for planning of treatment. Materials and method: This cross sectional study was carried out in the department of Anatomy, Sir Salimullah Medical College, Dhaka, Bangladesh from July 2011 to June 2012. The study comprised 199 fully ossified left sided dry femur of both sex (n=89 male, n=110 female). Sampling technique was purposive. Morphometric and topographic study was carried out on all samples by direct physical and photographic methods. Results: The most common position of nutrient foramen on the shaft of femur was found on the middle 1/5th in both male and female femur (50.78% in male and 56.86% in female respectively). Conclusion: The anatomical knowledge about this study might be useful in certain surgical procedures as well as micro vascular bone transfer to preserve the circulation.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14970 Delta Med Col J. Jan 2013;1(1):13-15

Download Full-text

Morphometric study of nutrient foramen of tibia in Jharkhand population

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213662 ◽

2021 ◽

Author(s):

Rajesh K. Kushwaha ◽

Rajiv Ranjan ◽

Makardhawaj Prasad

Keyword(s):

Bone Marrow ◽

Blood Vessels ◽

Blood Supply ◽

Morphometric Study ◽

Long Bones ◽

Posterior Surface ◽

Lateral Border ◽

Nutrient Foramen ◽

Nutrient Artery ◽

Nutrient Foramina

Background: Nutrient foramen gives passage to the nutrient vessels which supply major portion of the bone even bone marrow. Many vascular foramina are present in all bones for the passage of blood vessels. In long bones many small vascular foramina are present at the ends through which epiphyseal and metaphyseal blood vessels passes. In the shaft of long bones one or two larger foramina are present through which nutrient vessels passes. Nutrient artery provides 70% to 80% blood supply of long bones in children and if blood supply is decreased, it may lead to ischemia of bone resulting into less vascularisation of metaphysis and growth plate. Thus precise topographical knowledge of nutrient foramen is necessary for the surgeons to save the nutrient vessels during surgical procedures i.e. fracture fixation, bone grafting etc. Damage to the nutrient artery causes avascular necrosis of bone.Methods: Total 70 dry bones of tibia were taken in the study, without knowledge of sex of the bone. Position, number and direction of the nutrient foramen were noted.Results: single nutrient foramina present in 91.43% of cases and double in 6% of cases. 97.14 % nutrient foramina are directed downward and 2.86% directed upward. 90% nutrient foramina present on posterior surface, 1.42% on lateral surface and 8.57% on lateral border. 75% of nutrient foramina present in upper 1/3 and 25% in middle 1/3. Primary nutrient foramina (>24 G) present in 89.47% and secondary nutrient foramina (<24 G) present in 10.53% of cases.Conclusions: A sound knowledge of nutrient foramen topography, prevent the injuries of vasculature of bone during surgeries.

Download Full-text

Understanding tricuspid valve remodelling in atrial fibrillation using three-dimensional echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa058 ◽

2020 ◽

Vol 21 (7) ◽

pp. 747-755 ◽

Cited By ~ 3

Author(s):

Xochitl A Ortiz-Leon ◽

Edith L Posada-Martinez ◽

Maria C Trejo-Paredes ◽

Juan B Ivey-Miranda ◽

Jason Pereira ◽

...

Keyword(s):

Atrial Fibrillation ◽

Tricuspid Valve ◽

Three Dimensional ◽

Right Atrial ◽

Maximum Diameter ◽

Systolic Pulmonary Artery Pressure ◽

Minimum Diameter ◽

Circularity Index ◽

Significant Difference ◽

The Impact

Abstract Aims Atrial fibrillation (AF) has been associated with tricuspid annulus (TA) dilation in patients with severe functional tricuspid regurgitation (TR); however, the impact of AF is less clear in patients without severe TR. Our aim was to characterize TA remodelling in patients with AF in the absence of severe TR using 3D transoesophageal echocardiography (TOE). Methods and results Ninety patients underwent clinically indicated transthoracic and TOE: non-structural (NS)-AF (n = 30); AF with left heart disease (LHD) (n = 30), and controls in sinus rhythm (n = 30). Three-dimensional TOE datasets were analysed to measure TA dimensions using novel dedicated tricuspid valve software. The NS-AF group showed biatrial dilatation and normal right ventricular (RV) size with decreased longitudinal function compared to controls, whereas the LHD-AF group showed biatrial dilatation, RV enlargement, decreased biventricular function, and higher systolic pulmonary artery pressure compared with the other groups. Indexed TA area, minimum diameter, maximum diameter, and total perimeter were significantly larger in the NS-AF group than in controls (measurements in end-diastole: 6.4 ± 1.1 vs. 5.0 ± 0.6 cm2/m2, 1.8 ± 0.3 vs. 1.6 ± 0.2 cm/m2, 2.1 ± 0.3 vs. 1.9 ± 0.2 cm/m2, and 6.6 ± 0.9 vs. 5.9 ± 0.7 cm/m2, respectively, all P < 0.05). There was no significant difference in any indexed TA parameter between AF groups. TA circularity index (ratio between minimum and maximal diameters) and TA fractional area change between end-diastole and end-systole were no different among the three groups. Conclusion AF is associated with right atrial and tricuspid annular remodelling independent of the presence of LHD in patients with intrinsically normal tricuspid leaflets without severe TR.

Download Full-text

Changes In Left Atrial Appendage Orifice Following Percutaneous Left Atrial Appendage Closure Using Three-Dimensional Echocardiography

10.21203/rs.3.rs-662191/v1 ◽

2021 ◽

Author(s):

Xochitl Arely Ortiz-Leon ◽

Edith Liliana Posada-Martinez ◽

Alda Bregasi ◽

Wanwen Chen ◽

Ian Crandall ◽

...

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Three Dimensional ◽

Atrial Appendage ◽

Maximum Diameter ◽

Minimum Diameter ◽

Eccentricity Index ◽

Significant Difference ◽

Watchman Device ◽

Device Placement

Abstract Purpose: Percutaneous left atrial appendage (LAA) occlusion is increasingly performed in patients with atrial fibrillation and long-term contraindications for anticoagulation. Our aim was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of the LAA orifice and assess its impact on the adjacent left upper pulmonary vein (LUPV) hemodynamics.Methods: We included 50 consecutive patients who underwent percutaneous LAA occlusion with the Watchman device. Three-dimensional images of LAA pre- and post-device placement were analyzed offline. We measured the LAA orifice diameters in the long axis, and the minimum and maximum diameters, circumference, and area in the short axis view. Eccentricity index was calculated as maximum/minimum diameter ratio. The LUPV peak S and D velocities pre- and post-procedure were also measured.Results: Patients were elderly (mean age 76±8 years years), 30 (60%) were men. There was a significant increase of all LAA orifice dimensions following LAA occlusion: diameter 1 (pre-device 18.1±3.2 vs. post-device 21.5±3.4 mm, p<0.001), diameter 2 (20.6±3.9 vs. 22.1±3.6 mm, p<0.001), minimum diameter (17.6±3.1 vs. 21.3±3.4 mm, p<0.001), maximum diameter (21.5±3.9 vs. 22.4±3.6 mm, p=0.022), circumference (63.6±10.7 vs. 69.6±10.5 mm, p<0.001), and area (3.1±1.1 vs. 3.9±1.2 cm2, p<0.001). Eccentricity index decreased after procedure (1.23±0.16 vs. 1.06±0.06, p<0.001). LUPV peak S and D velocities did not show a significant difference (0.29±0.15 vs. 0.30±0.14 cm/s, p=0.637; and 0.47±0.19 vs. 0.48±0.20 cm/s, p=0.549; respectively).Conclusion: LAA orifice stretches significantly and it becomes more circular following LAA occlusion without causing a significant impact on the LUPV hemodynamics.

Download Full-text

The Anatomy of the Tibial Nutrient Artery Canal—An Investigation of 106 Patients Using Multi-Detector Computed Tomography

Journal of Clinical Medicine ◽

10.3390/jcm9041135 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1135 ◽

Cited By ~ 1

Author(s):

Haidara Almansour ◽

Eleftherios Armoutsis ◽

Marie K. Reumann ◽

Konstantin Nikolaou ◽

Fabian Springer

Keyword(s):

Computed Tomography ◽

Blood Supply ◽

Angular Position ◽

Tibial Fractures ◽

Non Union ◽

Screw Insertion ◽

Tibial Length ◽

Nutrient Artery ◽

Nutrient Foramina ◽

Significant Difference

Radiologic evaluation of the tibial nutrient artery is clinically important as disruption of tibial blood supply is a risk factor for delayed or non-union of tibial fractures. Damage to the tibial nutrient artery canal (TNAC) may occur by a traversing fracture or iatrogenic cause in the context of pin/screw placement. Furthermore, TNAC could be misdiagnosed as a stress fracture. The aim of this study was to characterize the normal anatomy of TNAC and to delineate its gender and side-specific differences. Patients who underwent contrast-enhanced computed-tomography encompassing the pelvis and lower extremities were included. TNAC was identified with an external and internal foramen and a traversing intercortical canal. Various anatomical morphometrics were evaluated: total number of nutrient canals, angular position of the outer and inner nutrient foramina, absolute and relative position of the nutrient foramina, as well as the intercortical canal length with respect to tibial length. The majority of patients of both genders had only one tibial nutrient canal, multiple canals or complete absence were rare. In most cases, the outer nutrient foramen was found on the posterolateral aspect of the upper-third of tibia at about 32% of tibial length; the inner foramen was found at the middle third of the tibia (41% of tibial length). The course of nutrient canal was mostly cranio-caudal with a small, but significant difference in relative canal length: 8.5% vs. 10% of tibial length for females and males, respectively. The angular location of the outer and inner foramen was between 20–30° and did not reveal a statistically significant difference between genders. No statistically significant side specific differences were found for all analyzed parameters and both genders. The clinical relevance of this anatomical study pertains to establishing “safe corridors” of pin/screw insertion in the context of surgical management of tibial fractures in order to avoid iatrogenic disruption of tibial blood supply.

Download Full-text