Figure 2 - available via license: Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported
Content may be subject to copyright.
Source publication
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 anato...
Context in source publication
Context 1
... each limb, the number, direction, diameter, and location of the nutrient foramina were recorded. The anatomic surface bearing the foramen was also noted. Foramina within 1 mm of the anterior or medial border were considered to be on that border. The diameters of the nutrient foramina were measured using a sliding caliper that was accurate to 0.01 mm (Figure ...
Similar publications
Background: Bone healing of fractures is still an open field for research due to its biological complexity. Adequately adapted experimental model is essential for understanding the factors
influencing the biological process of bone healing. Rabbits provide a good animal model for bone healing studies; its bone had Haversian system similar to human....
Background. The lower section of the Loncoche Formation (Late Campanian-Early Maastrichtian) outcropping at Ranquil-Có locality (Mendoza province, Argentina) has yielded a rich assemblage of vertebrates that was studied in 1995 by Gonzalez Riga. According to this author these vertebrate remains were found in a tidal paleoenvironment, resulting from...
The non-dinosaurian dinosauriform silesaurids are the closest relatives of crown-group dinosaurs and are thus, important for understanding the origins of that group. Here, we describe the limb bone histology of the Late Triassic silesaurid Sacisaurus agudoensis from the Candelária Sequence of the Santa Maria Supersequence, Rio Grande do Sul state,...
The anatomic variations which are ascertained via imaging and clinical co-relational findings exhibiting the intricate presence of complex network of neurovascular plexus / nutrient canal plexus presumably pointing out to the ascribing factors which could have led to repeated failure of dental anaesthesia and extended bleeding during dental extract...
Introduction Obturation as the final phase of endodontic treatment aims to provide complete hermetic filling along the entire length of the canal system from the coronal opening to the apical end. The aim of this study was to evaluate histological response of bone tissue on the implantaton of zinc oxide based material in artificially prepared defec...
Citations
... The nutrient foramen is an aperture in the bone's shaft that permits blood vessels to get to the bone's medullary cavity for nutrient and growth. Devascularization may result from an injury to the nutrient foramen caused on by trauma or surgical dissection [1,2]. Long bone fractures are becoming more common as a result of sports injuries, osteoporotic patients' pathological fractures, industrial and transportation accidents, and other causes. ...
... In clinical practise, palpable landmarks can be used to identify anatomical structures. There hasn't been any mention of a palpable landmark for the nutritional foramina in the literature [2,7]. Our study provides novel data, including the diameter and symmetry analysis of the nutrient foramen through which we can also comprehend variation in length. ...
Background: The largest and longest bone in the upper limb is the humerus. The nutrient foramen is an aperture in the bone's shaft that permits blood vessels to get to the bone's medullary cavity for nutrient and growth. The long bones' nutrient foramina have been the subject of numerous published research. Since the literature has not yet established a palpable landmark for the nutrient foramina, the purpose of this study was to characterize the nutrient foramen in dry adult humeri in terms of their numbers and location. Methods: The study comprised all the humerii (not necessarily paired and those of unknown age and sex) from the university of the Aam Admi Party's medical colleges. The length of the humerus, the number of nutrient foramen, the size of the nutrient foramen, the location of the nutrient foramen in regard to the surfaces and the zones, and the distance of the nutrient foramen from the midpoint of the humerus were all observed. All the data were recorded, and the percentage, mean, range, and standard deviation were computed as part of the statistical analysis. Results: In our study we examined 147 humeri. Among 147 examined humeri there were 82 right humerus and 65 left humeri. The number of single nutrient foramen was most commonly recorded among examined humerus (78.91%). The examination of humerus for location of nutrient foramen based on surface showed that more than four fifth of nutrient foramen were located on anteromedial surface (83.67%). The mean total length of humerus examined was 269.75±22.53 mm and the mean distance from of nutrient foramen from proximal end of humerus was 151.93±17.57 and calculated foraminal Index (FI) was 55.36%. Conclusion: When performing various surgical procedures on the humerus, such as treating fractures, bone repair, bone grafting, micro-surgical bone transplantation, in numerous fractures, and during extensive periosteal stripping, orthopaedic surgeons must have a thorough understanding of the anatomy of the number, location, and direction of the nutrient foramina of the humerus in order to minimise damage to the nutrient artery of the humerus. 2989 INTRODUCTION The largest and longest bone in the upper limb is the humerus. The nutrient foramen is an aperture in the bone's shaft that permits blood vessels to get to the bone's medullary cavity for nutrient and growth. Devascularization may result from an injury to the nutrient foramen caused on by trauma or surgical dissection [1,2]. Long bone fractures are becoming more common as a result of sports injuries, osteoporotic patients' pathological fractures, industrial and transportation accidents, and other causes. Orthopedic surgeons that perform treatments involving bone transplants, fracture repair, joint replacement, and vascularized bone microsurgery found this understanding of nutritional foramen to be of utmost importance. Limb bones grow more rapidly on one end than the other.The direction of the nutritional foramen is oriented towards the elbow in the upper limb as a result [3,4]. When the blood supply is not properly established, problems including a delayed union or a non-union of the fracture may occur. The necrosing cortex and the uniting callus of the fracture site are revascularized in part via the medullary arterial system. Understanding the location of the nutrient foramen and the relevant anatomy can help to reduce these issues. With this knowledge, the surgeon can limit complications from a delayed or incomplete healing of the fracture and prevent injury to the nutritional artery [5,6]. The long bones' nutrient foramina have been the subject of numerous published research. Few of this research have been carried out recently, and the majority date back many years. The humerus length was not given in great detail.Only the number, direction, and location of the nutrient foramina were discussed. In clinical practise, palpable landmarks can be used to identify anatomical structures. There hasn't been any mention of a palpable landmark for the nutritional foramina in the literature [2,7]. Our study provides novel data, including the diameter and symmetry analysis of the nutrient foramen through which we can also comprehend variation in length. Our study also aimed to analyse the nutrient foramen in dry adult humeri, with respect to the number, location of the nutrient foramen with respect to the surfaces and zones, and its distance from the mid-point of the humerus.
... However, non-unions still account for about 20-30% of cases [15][16][17] . These arise due to surgical techniques which, most of the time, interfere with the nutrient artery and the foraminal area, leading to poor vascularisation of the fracture area 5 . Knowledge of the number, size, location, position, and direction of the NF is critical to the preservation of blood supply to the long bones during fracture repair 3,12,13,18,19 . ...
... The topographical anatomy of the NF varies in different populations, and these variations may present challenges in managing humeral fractures 20 . While there have been few studies conducted on the topography of the NF on the humerus 5,6,10,12,18 , there are no such reports on the humerus in South African populations. There is evidence that the skeletal biology of South Africans, like limb proportion ratios and foramina sizes, is different from other regions [21][22][23] . ...
Fractures of the humerus are common on the midshaft of the bone, often causing injury to the nutrient artery. Successful fracture repair and healing requires preservation of the blood supply to the long bones which is conveyed through the nutrient foramina (NF). The topography of long bone NF varies in different populations. These variations can affect the preservation of blood supply to long bones during fracture repair management. The current study aimed to determine the topography and morphometry of the NF of the humerus in different populations of South Africa including the South African Africans (SAA), South Africans of European descent (SAED), and South Africans of mixed ancestry (SAMA). The study examined 596 dry humerii from the three South African populations, sourced from Raymond A. Dart Collection of Modern Human Skeletons. The parameters examined included the presence, number, location, position, size and direction of the NF, and foramina index (FI). The NF were present in 97.1% of the humerii. Majority of bones (76.8%) evinced a single NF with a diameter equal to or larger than 1.27 mm. The number of NF varied across the different population groups (p = 0.000), with SAA having more humerii presenting with a single NF and SAED having more humerii with two NF. The position of NF varied within and across populations (p = 0.002). Males in SAED had a higher mean FI on both the right (p = 0.030) (effect size = 0.258) and left (p = 0.022) (effect size = 0.421) sides than females. SAED had a lower mean FI than SAMA (p = 0.002) (effect size = 0.384). The location of NF varied across different populations (p = 0.000), with SAA having more NF located on the anteromedial surface and medial border, and SAED having more NF located on the lateral border (p = 0.000). NF were directed towards the distal ends of the shafts in 99.8% of bones and towards the proximal end in 0.2% of bones. The topography and morphometry of the nutrient foramina of the humerus are variable in the South African populations. Knowledge of the NF variations may aid in the management of humerus fractures.
... However, non-unions still account for about 20-30% of cases. These arise due to surgical techniques which, most of the time, interfere with the nutrient artery and the foraminal area, leading to poor vascularisation of the fracture area [30]. Knowledge of the number, size, location, position and direction of the nutrient foramina is critical to the preservation of blood supply to the long bones during fracture repair [2,3,12,13,23]. ...
... The humerus receives about 90% of its diaphyseal blood supply from a nutrient artery that enters the shaft through a nutrient foramen located just below the midpoint of the bone [11,30]. The nutrient foramen is an external opening to the nutrient canal that conveys nutrient vessels and nerves [15]. ...
... The topographical anatomy of the nutrient foramina varies in different populations, and these variations may present challenges in managing humeral fractures [22]. While there have been few studies conducted on the topography of the nutrient foramina on the humerus [3,11,13,21,30], there are no such reports on the humerus in South African populations. There is evidence that the skeletal biology of South Africans is different from other regions. ...
Purpose
Fractures of the humerus are common on the midshaft of the bone, often causing injury to the nutrient artery. Successful fracture repair and healing requires preservation of the blood supply to the long which is conveyed through the nutrient foramina (NF). The topography of long bone NF varies in different populations. These variations can affect the preservation of blood supply to long bones during fracture repair management. The current study aimed to determine the topography and morphometry of the NF of the humerus in different populations of South Africa including the SAA, SAED and SAMA.
Methods
The study examined 596 dry humeri from the three South African populations. The parameters examined included the presence, number, location, position, size and direction of the NF.
Results
The NF were present in 97.1% of the humeri. Majority of bones (76.8%) evinced a single nutrient foramen. The number of NF varied across the different population groups (P < 0.0001), with SAA having more humeri with a single NF and SAED having more humeri with double NF. The position of NF varied within and across populations (P = 0.002). Males in SAED had a higher mean FI on both the right (p = 0.03) and left (p = 0.022) sides than females. SAED had a lower mean FI than SAMA (P = 0.001). All humeri showed dominant-sized NF. The location of NF varied across different populations (P < 0.0001), with SAA having higher NF located on the anteromedial surface and medial border, and SAED having higher NF located on the lateral border (P < 0.0001). NF were directed towards the distal ends of the shafts in 99.8% of bones and towards the proximal end in 0.2% of bones.
Conclusions
The topography and morphometry of the nutrient foramina of the humerus are variable in the South African populations. Knowledge of the NF variations may aid in the management of humerus fractures.
... [11][12][13][14] In contrast, our mean value of the right side was lower than the value described by some other studies. [15][16][17][18] The mean value of left-sided humeri in the present study was nearly similar to the value described by several studies. 4,5,15,[19][20][21] The mean value we found for the left side was higher than the values described by some of the previous studies done in India. ...
The humerus bone of the humans is frequently used in anatomical science, forensic medicine and anthropological studies. This cross-sectional, descriptive study was done on 100 (43 right and 57 left) fully ossified dry human humerus in the Department of Anatomy, Mymensingh Medical College, Bangladesh, between July 2021 to June 2022. A non-random, purposive sampling technique was adopted. The maximum length was determined by measuring the distance between the most superior point on the head of the humerus and the most distal point of the trochlea of the humerus. The length was measured with a metallic scale, while the weight of the humerus was measured using a digital weighing machine. The mean (±SD) maximum length of the right humerus was 304.139 (±17.652) mm, while the left humerus was 300.42 (±20.779) mm. The mean (±SD) weight of the right humerus was 91.069 (±26.944) gm and the left humerus was 93.965 (±32.227) gm. A positive correlation was observed between the maximum length and the weight of the human humerus through regression analysis (r=0.653 and r=0.824 on right and life side respectively). The differences were statistically significant on both sides (P<0.001). CBMJ 2024 January: vol. 13 no. 01 P: 60-65
... Orthopedic and trauma surgeon have to be very cautious while handling nutrient artery which can prevent chances of delayed union or nonunion to a great extent. In some cases, surgical repair or revascularization procedures may be necessary to restore blood flow to the affected area and minimize the long-term consequences of the injury [7] . ...
Humerus, the long bone of the arm is commonly involved in accidents and injuries. Nutrient foramen is the significant structure, providing the life line in the form of blood vessels which are important for healing of fractures and other assaults. The present study was conducted on 302 dried and cleaned humerus bones of the right and left sides, present in the Department of Anatomy of MGM Medical College, Indore (M.P).The gender and age of the bones was not known. The number of nutrient foramina, their distribution over the surface and borders of humerus and their zone with respect to the three segments of humerus was studied. Bones which were damaged and having pathology were excluded from the study. After excluding the broken bones and the ones in which nutrient foramen could not be identified, 302 bones consisting of a total of 346 foramen were the part of the present study. The mean total length of humeri was 30.56 cm. Majority of humeri had a single nutrient foramen (76.82%). They were absent in 5.96% of bones. 58.09% of the bones had the nutrient foramen on the anteromedial surface with 25.43% bones having the nutrient foramen on the anteromedial border. This was followed by the posterior surface and then the anterolateral surface respectively. Maximum nutrient foramen were present in the II zone i.e middle zone of the bone. One bone had its nutrient foramen in the proximal one third segments. All foramen were directed downwards. Nutrient foramen is variable in its number and location, but functionally it is an extremely significant structure, influencing the nutrition and healing of the injuries, fractures and surgical interventions. Anatomical description of these foramen is hence of great assistance to treating physicians, orthopedic surgeons and in microvascular bone transplants.
... In cases of absence of nutrient foramina, the periosteal arteries remain the primary feeder to the bone (2). The postoperative functional rehabilitation following open fracture of fibula or any other long bone is to a great extent dependent on the blood supply (3). Also fibular grafts (both free vascularised fibular grafts and the more commonly practiced non-vascularised fibular grafts) have been extensively used in repair of bony defects (4). ...
Background:
The fibula is a long bone located at the lateral aspect of the leg. Diaphysis of fibula is supplied by one or more nutrient arteries through an opening referred to as the nutrient foramen. Mor-phometric studies of the nutrient foramina of fibulae are very sparse in literature.
Materials and methods:
This cross-sectional descriptive study was conducted on 51 dry adult human fibulae housed in the department of anatomy, AIIMS, New Delhi. Total fibular length along with the number and location of all nutrient foramina present were recorded. Foraminal indexes (FI) of the fibulae were calculated as well.
Results:
The study revealed that the average length of fibulae was 35.48 ± 1.76 cm. 94% fibulae had a single nutrient foramen and 6 % had two. In fibula with single foramen, the most common location was on the medial crest (50%), followed by between medial crest and posterior border (35%), between the medial crest and interosseous border (8%) and on posterior border (6%). Nutrient foramen was located in middle 1/3rd of shaft in 98 % and in inferior 1/3rd of shaft in 2 % of fibulae. The average foraminal index was 44.85 ± 6.67% with a range of 35.7 to 63.8%.
Conclusion:
Most common location of nutrient foramen in fibula is middle 1/3rd of shaft on the medial crest with dual nutrient foramina in 6% of fibulae. These parameters show variability in different geographical location and population groups. These data may be helpful for anthropologists, forensic experts, radiologists and might guide in harvesting vascularised fibular bone graft.
... Inappropriate treatment or poor surgical techniques may cause rupture of the FN or nutrient artery. This leads to additional interventions that need to be repeated [10,11]. Detailed data on bone nutrition are always important in the development of new transplantation and resection techniques in orthopedics [4]. ...
... With the developments in bone fixation techniques and increasing patient demands, bone fractures are treated more surgically rather than conservatively. This situation is associated with high cost and complication risks [10]. ...
Objectives: The most principal nutrition source of a bone is nutrient arteries. They are important at every stage of bone development. A nutrient artery enters a bone through the nutrient foramen, the largest hole on the outer surface of the bone. The foramen is important both morphologically and clinically. Methods: A total of 414 adult human dry bones were investigated in this study to identify topographic and morphological features of nutrient foramina in the scapula, clavicle, humerus, radius and ulna. Nutrient foramina were examined with a hand lens. Their dimensions and directions were determined with a 21-gauge needle, and thus major foramina were detected. Positions of nutrient foramina were noted according to surfaces of the bones, and to segments separated as proximal, middle and distal by calculating foraminal index. Results: A single nutrient foramen was found in 71% of our samples. We observed that 94.2% of foramina in the clavicle, 89.3% of foramina in the humerus, 51.3% of foramina in the radius, and 67.7% of foramina in the ulna were located in the middle 1/3 segment of the bones. Conclusion: Our findings were in line with the data in the literature. On account of pathologies associated with the nutrient foramen, our findings may be helpful for surgeons to design applications performed in the region. In addition, we think that our data by contributing to the literature may be a resource for clinicians due to the importance of the nutrient foramen for surgical procedures.
... Oblique radiography is often required to fully assess the extent of the fracture, while NC that pass throughout the cortex can often mislead and be pronounced as a fracture. In our study, all NC on radii and ulna were directed toward the proximal part, while NC in humerii distally penetrated the cortical bone layer, which is in agreement with other results found in the literature [17,26]. Because of such anatomical position of NF, safe zones for procedures such as insertions of pin on ulna, during pronation, would be along the whole axis between the extensor carpi ulnaris and the flexor carpi ulnaris, while for radius, during supination, any pins need to be inserted under direct vision using retractors down to the bone to avoid injury of nutrient artery. ...
Objectiv : Anatomic characterization of the nutrient artery of upper extremity long bones differs among the several textbooks on human anatomy. To elucidate the anatomical features of the nutrient foramen (NF) through which the nutrient arteries pass, we examined the morphology and topography of the NF on the diaphysis of the long bones of the upper extremities.
Methods : A total of 150 (50 humeri, 50 radii, 50 ulnae) macerated and degreased adults, long bones of the upper extremities, unknown age, and gender were used as material in this study. The following parameters were determined for each bone: total number of NF, foramina index (FI), total bone length, position of the NF based on the FI value and the surface of the shaft/body of the bones, and obliquity of the nutritional canal (NC).
Results : The largest number of NF was found on the middle third of the anteromedial side of the humerus diaphysis, with NC directed distally, that is, towards the elbow. Radius and ulna had predominantly one NF, on middle third of anterior surface, with NC directed proximally.
Conclusion : This study provides additional and important information on the location and number of NF in the long bones of the upper and lower extremities in the Bosnian and Herzegovinian population.
... Patake [15] and Mysorekar [32] opined that the number of foramina does not seem to have any significant relation to the length of the bone. Also, according to several other studies [33][34][35] the distribution of the NF within the long bone shaft of upper and lower limb is not related to the length of the shaft. Zhiquan et al. [36] found the mean total bone length for humerus was 305.12±16. ...
... In the setting of reconstructive surgery, the use of vascularized allografts has been proven effective albeit challenging [38]. Vascularized bone and joint allograft survival is strongly contingent upon preservation of periosteal and intraosseous blood supply [35]. Hence, graft preservation methods as well as surgical techniques depend upon a thorough understanding of vascular anatomy. ...
... Patake [15] and Mysorekar [32] opined that the number of foramina does not seem to have any significant relation to the length of the bone. Also, according to several other studies [33][34][35] the distribution of the NF within the long bone shaft of upper and lower limb is not related to the length of the shaft. Zhiquan et al. [36] found the mean total bone length for humerus was 305.12±16. ...
... In the setting of reconstructive surgery, the use of vascularized allografts has been proven effective albeit challenging [38]. Vascularized bone and joint allograft survival is strongly contingent upon preservation of periosteal and intraosseous blood supply [35]. Hence, graft preservation methods as well as surgical techniques depend upon a thorough understanding of vascular anatomy. ...
Aims: Nutrient artery is the principal source of nutrition to the long bones. The topography of nutrient foramina on long bones is well known, but it has not yet been established whether the number of nutritive foramina (NF) is related to total bone length. The objective of the present study was to study the correlation of total number of nutrient foramina and long bone length of upper and lower limb to provide detailed data on such features. Study Design: A cross-sectional, descriptive study Place and Duration of Study: Department of anatomy, Medical Faculty University of Sarajevo. Study duration was 3 months. Methodology: In the present study, 300 adult human long bones of the upper (50 humeri, 50 radii, 50 ulnae) and lower (50 femora, 50 tibiae, 50 fibulae) limbs were investigated to determine the number of their nutrient foramina. The nutrient foramina were identified analysed macroscopically and total number of nutrient foramina for each bone was recorded. Total length of each bone within a group was recorded. Statistical analysis was performed to determine correlation between total bone length and number of nutrient foramina, by using SPSS version 17.0 for Windows. Results: A statistically significant negative correlations between the left humerus length and the number of NF was found. A positive correlations between the length of the right radius and the number of NF, the left ulna length and the number of NF, the right ulna length and the number of NF were found. A negative correlations between the length of the left radius and the number of NF and between right humerus length and number of NF were found. A positive correlation between the length of the right and left femur and the number of NF were found. A negative correlation between the length of left tibia and the number of NF was found, as well as negative correlation between the length of right and left fibula and number of NF. Conclusion: Total bone length is not related to the number of nutrient foramina. The number of nutrient foramina does not depend on the total length of the bone, which is important when assessing the success of grafts for transplantation on long bones in taller people.
