Evaluation of Nutrient Foramen in Adult Dry Human Femur

BACKGROUND Nutrient foramen is a large opening that transfers the arteries that supply the bone to the bone cavity. During surgical procedures, it is very important to have precise and complete information about the location of the foramina to determine whether the fracture line passes close to the nutrient foramina. The purpose of this study was to determine the number and position of the femoral nutrient foramina together with morphometric measurements. METHODS A total of 93 dry adult femurs with unknown sexes were examined in this study. The direction, location and the total number of nutrient foramina of the femur were investigated by using an anthropometer (Lafayette instrument, Indiana). Also, foraminal index was calculated. RESULTS The analysis revealed that 28 (53.8 %) of the femurs with a single nutrient foramen were on the right side and 22 (53.7 %) were on the left side, respectively. Femurs with double nutrient foramina were 23 (44.2 %) and 18 (43.9 %) on right and left sides, respectively. Femurs with triple nutrient foramina were 1(1.9 %) and 1 (2.4 %) on right and left sides, respectively. The foraminal index of femurs was found as (41, 58 %) and (42, 23 %) on the right and left sides, respectively. The nutrient foramen was mostly 84 (90.3 %) located at the middle third of the femur. CONCLUSIONS The findings of this study provide information and details about nutrient foramen which have clinical importance, especially in surgical procedures like bone grafting and microsurgical vascularized bone transplantation. KEY WORDS Femur, Foraminal Index, Nutrient Artery, Nutrient Foramina

Morphometric study of nutrient foramen of tibia in Jharkhand population

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.

Anatomical study of nutrient foramen in lower limb dry long bones

Background: Nutrient artery gain access through nutrient foramen and provide vascular supply to bone. Number, size and location of nutrient foramen has significant medical as well as surgical importance. Any insult to nutrient artery during surgical procedure or during trauma may lead to devascualarization or poor prognosis.Methods: The present study consist of 50 femurs, 50 tibia and 50 fibula, collected from department of anatomy, BPKIHS. Mean length of bone, number, position and size and foraminal index of nutrient foramen was observed and recorded accordingly.Results: In femur 62% bone shows single nutrient foramen. Nutrient foramen was commonly located in medial lip of linea aspera and in upper third of bone which was noted in 80% of bone. In tibia 82% of total bone shows single foramen with absent of foramen in 6% bone. Foramen was commonly located above the soleal line and middle third of bone which was noted in 56% of bone. In fibula 6% of total bone shows absent of nutrient foramen and majority of bone shows single nutrient foramen (82%). Foramen was commonly located in lower part of posterior surface (60%) and in middle third of bone.Conclusions: This study provides details topographic knowledge about nutrient foramen which is important clinically for proper planning of surgery and its outcome.

Morphometric Study of Nutrient Foramina in Dry Human Clavicles in Central India

BACKGROUND The clavicle or collar bone is a modified long bone. It is the first bone to ossify in the membrane. The inferior surface of shaft of clavicle presents a subclavian groove. A nutrient foramen lies at the lateral end of the groove. The nutrient artery is derived from the supraclavicular or clavicular branch of thoracoacromial artery. A bone is supplied by a nutrient artery which passes through the small tunnel called as nutrient foramina. In orthopaedic procedures to preserve the circulation, the topographical knowledge of the nutrient foramen is important. The study was undertaken to analyse nutrient foramina in adult human clavicles in relation to their number, position, direction, and distribution over bone length. METHODS Our study consisted of 67 adult dry human clavicles (31 right sides and 36 left sides). The number, topography and direction of the foramina were studied. The distance of foramina from the sternal end & total length of the clavicles were measured in millimetres by using digital Vernier calipers. The foramen index was calculated by applying the Hughes formula: FI = (DNF TL) x 100. RESULTS Nutrient foramina were present in all the clavicles. Most of the clavicles have single nutrient foramen. We observed 62 (68.13 %) foramina on the posterior surface mostly in the middle 1 / 3rd region. All the nutrient foramina were directed towards acromial end and the foramina index (FI) was 50.2. CONCLUSIONS The topographical knowledge of the nutrient foramen is important in orthopaedic procedures like nail plating, K wire fixation, reduction, internal fixation devices for the treatment of fracture, coracoclavicular ligament repair and in free vascularized bone graft to preserve the circulation. KEY WORDS Clavicle, Nutrient Foramina, Nutrient Artery, Foramina Index (FI)

A Study on Variations of Nutrient Foramen of Humerus in Kurnool, Andhra Pradesh, India, and Its Clinical Relevance

BACKGROUND Nutrient foramen of humerus is an opening in the shaft of humerus which conducts nutrient vessels for medullary cavity. Major source of blood supply to long bone is the nutrient artery. Knowledge regarding nutrient foramen is important for orthopaedic surgeons while doing any procedure on humerus like bone grafting, plating and also plays an important role in fracture healing. We wanted to determine the location, number, and direction of nutrient foramen of humerus. METHODS The observational study was conducted on 72 adult humeri (36 of right side and 36 of left side) collected from Department of Anatomy, Kurnool Medical College, Kurnool, Andhra Pradesh from 15th September to 31st October 2020. Each humerus was observed for location, number, and direction of nutrient foramen in relation with surface, border andzone. RESULTS In the present study it has been observed that 61 % of humeri had a single foramen, 31 % had two foramina and 8 % had 3 foramina. Majority of nutrient foramina (54.95 %) were present on antero-medial surface, 12.08 % on anterolateral surface, 12.08 % on posterior surface, 19.78 % on medial border, and 1.09 % on lateral border. It was also concluded that most (94.50 %) of the foramina were present in the zone II followed by zone III (3.30 %) then by zone I (2.19 %). CONCLUSIONS Knowledge of number and location of the nutrient foramina in humerus will be helpful in preventing intra-operative injury of nutrient artery during orthopaedic, plastic and reconstructive surgery; and will also be relevant in medico legal practice. KEY WORDS Nutrient Foramen, Humerus, Nutrient Artery, Foraminal Index, Clinical Implications

Morphology, Topography and Clinical Significance of Primary Nutrient Foramina in Tibia

BACKGROUND Nutrient foramina are seen in the shaft of long bones. They vary in number, size and their position on the surface of bones. It transmits the nutrient artery which is the main source of blood supply to the long bones. We intend to study the location, number, type and direction of primary nutrient foramina (PNF) on the shaft of tibia. METHODS The descriptive study was done using 120 tibiae (right-66, left-54) from Department of Anatomy, Govt. Medical College, Thiruvananthapuram. Length of each bone and distance of the nutrient foramen from the upper end of tibia was measured using osteometric board. The location of the primary nutrient foramina on the surface of tibia, the direction of the nutrient canal and the presence of secondary nutrient foramina were noted. RESULTS Single primary nutrient foramina were located on the posterior surface of 113 tibiae. 4 tibiae showed PNF and secondary nutrient foramina (SNF). No nutrient foramina were observed in 3 tibiae. CONCLUSIONS The precise knowledge and topography of PNF of tibia will help orthopaedic surgeons in minimising damage to vasculature of tibia during various surgical procedures. KEY WORDS Tibia, Nutrient Foramen, Nutrient Artery

Diaphyseal Tibial Nutrient Foramen in Goan Population - A Morphometric Study with Clinical Implications

BACKGROUND Tibia is the weight bearing bone of the leg. Usually it has a single nutrient foramen located posteriorly near the soleal line and transmits a branch of posterior tibial artery. The nutrient artery is the principal source of supply to a long bone. We carried out this study to find out the number, size, location, position and direction of the diaphyseal nutrient foramen in dried human tibia in Goan population. METHODS The study was carried out on 66 unpaired dry human tibiae of unknown age, gender and without deformity in the Department of Anatomy, Goa Medical College, using sliding and digital Vernier callipers, 20- and 24-gauge needles. Hughes formula was used to compute foraminal index. The data was statistically analysed with SPSS software version 23. RESULTS Most of the tibia in our study had a single nutrient foramen. Majority of the nutrient foramina were medium sized and directed downwards in our study. In 81.42 % tibiae, the nutrient foramina were present in the upper 1 / 3 rd of the shaft and in 18.57 % in the middle 1 / 3 rd of the shaft of the bone. Almost all nutrient foramina in the upper 1 / 3 rd of posterior surface were situated lateral to the soleal line. We computed the mean foraminal index as 30.25 % with standard deviation of 6.14. CONCLUSIONS A proper knowledge of morphometry and topography of the nutrient foramen is of utmost importance to orthopaedic surgeons as the nutrient artery may get damaged if fracture line passes through the nutrient canal. Also, it will help the surgeon to conserve vascular supply while performing bone grafting and fracture reduction. KEYWORDS Nutrient Foramen, Morphometry, Foraminal Index, Soleal Line

Morphological study of nutrient foramen in adult human clavicles

Introduction: The Clavicle is a modified long bone and only long bone which is placed horizontally and subcutaneously at the root of neck. It transmits the weight from upper limb to the axial skeleton. Nutrient foramen is the largest foramen on the long bones through which nutrient artery for the bones passes. The nutrient artery is the principal source of blood supply to a long bone, particularly important during its active growth period in the embryo and foetus, as well as during the early phase of ossification. The bone has a cylindrical part called the shaft and two ends, lateral and medial. The shaft is divisible into the lateral one-third and the medial two-thirds. The inferior surface of shaft of clavicle presents a subclavian groove. A Nutrient foramen lies at the lateral end of the groove running in a lateral direction. Aims & objectives: To note the position, number and direction of nutrient foramen Materials and Methods: The present study was performed on 100 adult human clavicles of unknown sex and age collected from the department of anatomy, Mysore medical college and research institute, Mysore. Clavicles were examined by direct observation to note the position, number and direction of nutrient foramen. A magnifying lens was used to observe the foramina. Results: The study was conducted on 100 adult human clavicles (50 right and 50 left), and we observed the following results: Nutrient foramina were present in 97 clavicles - 49 clavicles (right) and 48 clavicles (left). Single foramina was present in 80 clavicles, 41 clavicles (right) and 39 clavicles (left) Double foramina were present in 17 clavicles, 8 clavicles (right) and 9 clavicles (left). Absence of nutrient foramina were found in 3 clavicles, 1 clavicle (right) and 2 clavicles (left). All foramina were directed towards the acromial end of the clavicle. Conclusion: The knowledge of anatomical variations of nutrient foramina in clavicles are important for surgeons for performing surgical procedures like bone grafting and microsurgical vascularised bone transplantation. KEY WORDS: Clavicle, Nutrient Foramen, Bone Graft.