Morphological and Topographical Anatomy of Nutrient Foramen in The Lower Limb Long Bones: Alt Ekstremite Uzun Kemiklerinde Foramen Nutricium’ların Morfolojik ve Topografik Anatomisi

Syeda Uzma Zahra; Piraye Kervancıoğlu; İlhan Bahşi

doi:10.5152/eurjther.2017.147

Authors

Syeda Uzma Zahra Department of Anatomy, Gaziantep University, School of Medicine, Gaziantep, Turkey https://orcid.org/0000-0002-7557-4768
Piraye Kervancıoğlu Department of Anatomy, Gaziantep University, School of Medicine, Gaziantep, Turkey https://orcid.org/0000-0003-3231-3637
İlhan Bahşi Department of Anatomy, Gaziantep University, School of Medicine, Gaziantep, Turkey https://orcid.org/0000-0001-8078-7074

DOI:

https://doi.org/10.5152/eurjther.2017.147

Keywords:

Nutrient foramina, femur, tibia, fibula, foraminal index

Abstract

Objective: The present study aims to determine the number and position of the nutrient foramina (NF) of the human femur, tibia, and fibula and to observe the size, direction, and obliquity of the nutrient foramina.

Methods: We observed 265 adult human, lower limb long bones in the Department of Anatomy of the Gaziantep University. The nutrient foramina were identified with naked eyes, and the obliquity was determined with a hypodermic needle. Gauge 20 and 24 needles were used for size determination. Shape was observed with the naked eye and classified into oval and round types. The nutrient foramina location was determined by dividing total bone length into three segments, and the locations were validated by calculating foraminal index (FI).

Results: Results showed that 79% of the long bones had a single nutrient foramen. More than 96% of the nutrient foramina were directed away from the knees. A total of 87% of the femoral foramina were located in the middle third, 72% of the tibial foramina were located in the proximal third, and 98% of the fibular nutrient foramina were located in the middle third of the specimens. Overall, no foramina were found on the distal third of the studied bones.

Conclusion: Our study findings are in accordance to the findings from several research studies. The assessment of pathological conditions associated with the findings of foramen nutricium in our study may help clinicians and surgeons in planning treatments for applications to be performed in this region. However, it is thought that literature will be a source for basic and clinical sciences by providing reference values.

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References

Gray, Drake RL, Vogl AW, & Mitchell AW. Gray’s Anatomy for Students. 2nd edition. London: Churchill Livingstone; 2004.

Martini FH, Timmons MJ, Tallitsch RB. Human Anatomy. 8th edition. Illinois: Pearson Benjamin Cummings; 2015.

Saladin KS. Human Anatomy. 4th edition. New York: Mc Graw Hill; 2014.

Agrawal N, Parmar AS, Naik DC. Correlation between number and size of nutrient foramina to bone length: An anatomical study in lower limb long bones. Int J Anat Res 2016; 2: 8-11.

Rhinelander FW. The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Joint Surg 1968; 50: 784-800.

Ukoha UU, Kosisochukwu EU, Henry CN, Damian NE, Obioma CE, Izuchukwu FO. A study of nutrient foramina in long bones of Nigerians. Tech orthop 2013; 2: 304-8.

Craig JG, Widman D, Van Holsbeeck M. Longitudinal stress fracture: patterns of edema and the importance of the nutrient foramen. Skel Radiol 2003; 32: 22-7.

Sissons H, Kember N. Longitudinal bone growth of the human femur. Post Med J 1977; 53: 433-37.

Collipal E, Vargas R, Parra X, Silva H, Sol M. Diaphyseal nutrient foramina in the femur, tibia and fibula bones. Int J Morph 2007; 25: 305-8.

Hughes H. The factors determining the direction of the canal for the nutrient artery in the long bones of mammals and birds. Acta Anat 1952; 15: 261-80.

Longia GS, Ajmani ML, Saxena SK, Thomas RJ. Study of diaphyseal nutrient foramina in human long bones. Acta Anat 1980; 107: 399-406.

Lutken P. Investigation into the position of the nutrient foramina and the direction of the vessel canals in the shafts of the humerus and femur in man. Acta Anat 1950; 9: 57-68.

Laing PG. The blood supply of the femoral shaft. J Bone Joint Surg 1953; 35: 462-66

Al-Motabagani MAH. The arterial architecture of the human femoral diaphysis. J Anat Soc India 2002; 51: 27-31.

Kizilkanat E, Boyan N, Ozsahin ET, Soames R, Oguz O. Location, number and clinical significance of nutrient foramina in human long bones. Ann Anat 2007; 189: 87-95.

Agarwal N, Tiwari A, Naik CD. An analytical study of number, position, size and direction of nutrient foramina of femur. Int J Med Sci Pub Health 2016; 5: 489-92.

Mysorekar VR. Diaphysial nutrient foramina in human long bones. J Anat 1967; 101: 813-22.

Gumusburun E, Yucel F, Ozkan Y, Akgun Z. A study of the nutrient foramina of lower limb long bones. Surg Radiol Anat 1994; 16: 409-12.

Forriol CF, Gomez PL, Gianonatti AM, Fernandez-Valencia R. A study of the nutrient foramina in human long bones. Surg Radiol Anat 1987; 9: 251-5.

Gupta RK, Gupta AK. A study of diaphyseal nutrient foramina in human femur. Int J Res Med Sci 2016; 4: 706-12.

Sendemir E, Cimen A. Nutrient foramina in the shafts of lower limb long bones: situation and number. Surg Radiol Anat 1991; 13: 105 -8.

McKee NH, Haw P, Vettese T. Anatomic study of the nutrient foramen in the shaft of the fibula. Clin Orthop Relat Res 1984; 184:141-4.

Mathur A, Sharma MD. Study of nutrient foramina of fibula with other long bones: A central Rajasthan study, Int J Med Res Prof 2016; 2; 155-7.

Kirschner MH, Menck J, Hennerbichler A, Gaber O, Hofmann GO. Importance of arterial blood supply to the femur and tibia for transplantation of vascularized femoral diaphysis and knee joints. World J Surg 1998; 22: 845-52.

Seema, Poonam V, Anupama M, Deepinder G. Variation in the number and position of nutrient foramina of long bones of lower limn in North Indians. Int. J Anat Res 2015; 3: 1505-09.

Trueta, J. Blood supply and the rate of healing of tibial fractures. Clin Orthop Relat Res 1974; 105: 11-26.

Carroll SE. A study of the nutrient foramina of the humeral diaphysis. J Bone Jt Surg 1963; 45: 176-81.

Murlimanju BV, Prashanth K, Prabhu LB, Chettiar GK, Pai MM, Dhananjaya K. Morphological and topographical anatomy of nutrient foramina in the lower limb long bones and its clinical importance. Aus Med J 2011; 4: 530-7.

Nagel A. The clinical significance of the nutrient artery. Orthop Review 1993; 22: 557-61.

Moore KL, Dalley AF, Agur AM. Moore Essential Clinical Anatomy. China: Wolters Kluwer; 2014.