Nutrient Foramen Research Articles

Morphometric And Comparative Study Of Nutrient Foramina Of Femur And Humerus Bones And Its Clinical Importance In Egyptian Population

Background : knowledge with respect to nutrient foramina of bones is helpful in surgeries, for example, microvascular bone exchange to safeguard the dissemination. In any case, there is not many information on Morphometric investigates of the supplement foramina of femur and humerus in Egyptians. Subjects and methods : Between June 2019 and September 2020, we prospectively assess morphology of nutrient foramina included 350 adult long limb bones of femur and humerus Department of Anatomy in Al-Azhar University . the age and gender of which were not determined of Egyptian subjects. The bones were examined for the number, location and direction of the nutrient foramina. Aim of the work : To investigate the morphology of nutrient foramina of femur and humerus regarding to their numbers and localizations and to determine their foraminal index to provide detailed data on such features. Results : The foramina were most determined in anteromedial aspect 61% of cases on the shaft of bone in the humerus , its foramial indices were 32.1 – 68.7 % and the most of study (84%) had one nutrient foramen. In femur, we founded that the range of foraminal indices of bone 26.1 – 68 % , mainly sample (88% ) located in the middle third of the bone and (30%) had one nutrient foramen, (60%) had two nutrient foramina and only (10%) had three nutrient foramina. 56.1% nutrient foramina were located in between upper and middle 1/3rd of the Femur,,18.7% nutrient foramina were located in between middle and lower 1/3rd of the Femur ,, 23% nutrient foramina were located in middle half of the length of the Femur. Foraminal Index (FI): (Distance of nutrient foramen / Total length) ×100 Conclusion: The anatomical information of the nutrient foramen of the long bones of limb as femur and humerus is important for orthopaedic surgeons during surgical operations of bones.

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.

Anatomic characterization of the tibial and fibular nutrient arteries in humans.

The location of nutrient foramina has been extensively studied in long bones; however, accurate information on the origin and extra-osseous course of the nutrient artery remains clearly defined in some long bones, although it is crucial to protect the nutrient arteries during operative procedures. In this study, we elucidated the origin and extra-osseous course of tibial and fibular nutrient arteries based on the 54 cadaveric legs. The tibial nutrient artery typically arose from the posterior tibial artery. Some of the tibial nutrient arteries arose from the anterior tibial, popliteal, and fibular arteries. The tibial nutrient artery arose from these parent arteries as a long descending branch. It penetrated the most proximal portion of the tibialis posterior or flexor digitorum longus to enter the tibial nutrient foramen. The fibular nutrient artery arose from the fibular artery as a short descending branch in all the cases. The fibular nutrient artery penetrated the flexor hallucis longus to enter the fibular nutrient foramen. Our present and previous findings provide new insight into the anatomical characteristics for the nutrient arteries in the long bones of upper and lower extremities. Namely, the nutrient arteries of the long bones go away from the elbow or knee to enter the nutrient foramina.

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.

A Topographical Study of Nutrient Foramen in Human Fibulae

Introduction: The fibula is very well known amongst the surgeons for their usage in bone grafting. The vascularised bone graft is necessary for successful procedure. The vasculature of the bone graft is maintained by procuring the intact nutrient artery along the donor site of the bone. The nutrient artery enters the shaft of the bone through the nutrient foramen. The topographical study of nutrient foramen in human fibulae will benefit the operating surgeons in the surgical procedures like open reduction fracture of the fibula and bone grafting. Aim: To record the position, location, number and direction of the nutrient foramen of the fibula. Materials and Methods: A descriptive study on 100 human dried fibulae obtained from the Department of Anatomy, Seth GSMC and KEM hospital, Mumbai, Maharashtra, India were done from February 2013 to July 2013. A magnifying hand lens and a thin stiff wire to confirm the number and direction of nutrient foramen were used. The lengths of the fibulae were measured and divided into three equal parts. The position and location were determined by identifying the anatomical position and the side of the fibula. The simple statistical method by calculating frequency (n) and percentages (%) in all categories and sub-categories of the collected data was applied to the study. Results: In 17.24% of fibulae the foramen was directed towards the growing end. In 7% of fibulae, there was no foramen, 23% fibulae were having two foramina, and 70% were having one foramen. The nutrient foramen was located maximally on the posterior surface of the fibula (84.48%) and in the middle one- third (81.03%). Conclusion: This study has provided information on the topography of nutrient foramen of the fibula. This knowledge will be useful in certain surgical procedures to preserve the vascularity of fibula.

A Study on Morphological Features of Nutrient Foramen of the Tibia in Human Population of South Bihar Region

Background: Tibia is weight-bearing long bone. Nutrient arteries are the prime source of blood supply for any long bone including tibia. A study of dimensions and location of nutrient foramen and direction of the nutrient artery canal can give an insight into the role that these arteries play in development and sustenance of bone. The objective of the study was to present the morphological features of nutrient foramen of the tibia in South Bihar region. Materials and Methods: Sixty tibias (30 of each side) were used for the study. Morphometric analysis of bones was done to find out number, position, and direction of nutrient foramen. We did a comparative study of our findings with observation of previous workers. Results: All bones had nutrient foramen. Five percent had double while 95% bones had single foramen. Nutrient canal was directed downward in all bones except one. In 84.13% of bones, nutrient foramen was on the posterior surface; foramen was lateral to the soleal line in 81.13% of these bones. 80.95% of the foramens were situated in the superior third of the tibial shaft. Conclusion: Knowledge about possible variations in number, position, and direction of nutrient canal can be of use for preservation of nutrient vessels during surgical procedures as well as in prognostic evaluation of the treatment given.

A Study of Diaphyseal Nutrient Artery Foramina of Dry Fibula in Human, done in a Government Medical College of Upper Assam, India

Introduction: The nutrient foramina is the external opening in each bone which has a particular position and number in its diaphysis. A thorough knowledge of the position, number, direction and variation of the nutrient foramina of fibula is very much important, as this is one of the most common bone used in bone grafts, vascularised bone microsurgery and mandibular reconstruction. Aim: To determine the position of nutrient artery foramina in fibula and also their size and direction. Materials and Methods: This was a descriptive cross-sectional study which was conducted in the Department of Anatomy, Assam Medical College, Dibrugarh, Assam, India, from March- June 2021. The study was conducted on 167 numbers of adult human cleaned and dried fibulae. The number, position, size and direction of nutrient foramina were recorded in a pretexted proforma. Foraminal Index (FI) was calculated and the range, mean and standard deviation of FI were determined. Results: In the present study, 167 bones were taken but only 159 showed nutrient foramina. Single dominant foramen was found in 92.5% (147/159) of bones. Secondary foramina were present in 7.5% (12/159) of bones. The FI was calculated. According to FI, maximum number of foramina was present on middle third of fibula (92.56%). In 7.44% of fibula the foramina were located in distal third of the bone. Conclusion: A thorough anatomical knowledge of the nutrient foramen is useful in planning the vascularised fibular graft. Hence the result of this study will provide detail data about the number, position and direction of nutrient artery foramina in fibula for successful outcome of various orthopaedic and plastic reconstructive surgeries.

A Study of Morphometric and Topographic Anatomy of Nutrient Foramen in Fibula

Introduction: Long bones receive its primary blood supply from the nutrient arteries. They are transmitted through oblique canals, called nutrient foramina, into its diaphysis. Knowledge of foraminal topography helps to preserve bone vascularity during surgeries. Aim: To estimate the morphometric and topographic characteristics of diaphyseal nutrient foramina of fibula. Materials and Methods: A descriptive osteometric and morphological assessment of 50 dry fibulae of unknown age and sex were done. The samples were obtained from the Department of Anatomy, Kanyakumari Government Medical College, Asaripallam, Tamil Nadu, India. The length of each bone was measured directly using a measuring tape. Number, location and the direction of nutrient foramina were observed and the data were presented in a tabulated format. Results: The mean height of the fibula on the right side was 35.86±2.441 cm, whereas on the left was 36.64±2.537 cm. It was observed that 92% of the right and 96% of the left bones presented a single foramen. The nutrient foramina were predominately present on the posterior surface of the middle third of the shaft and were directed away from the growing end of the bone. Conclusion: As vascularised osteocutaneous fibular graft is recommended as a useful treatment option for bone transplant surgeries, the data gathered in this study could be useful for the orthopaedic surgeons.

Study of Nutrient Foramen in Humerus

Background
 Nutrient foramen is the gateway for the nutrient artery to provide nutrition in different parts of the bone which play important role in healing during fracture, trauma and also important for bone grafting. The aim the study is to identify the number of nutrient foramen in dry humerus and to observe direction as well as allocation of the nutrient foramen in surfaces and borders.
 Methods
 The sample for the study were collected from medical and dental colleges of Nepal in years ranging from 2018 to 2020 AD and the height were measured by the help of using vernier caliper, probe was introduced in nutrient foramen to confirmed its direction. The numbers of nutrient foramen were noted in copy and analyzed the statistics by using software called the SPSS (Statistical Package for the Social Sciences) 20.
 Results
 In the study of 200 sample of humerus from the department of anatomy from different medical and dental college of Nepal includes Nepal Medical College, Kathmandu University School of Medical Science, M.B. kedia Dental College and Lumbini Medical College. Out of 200 sample, 74 were right and 126 were left Humerus of human body. In 143 bone (i.e. 71.5%) a single nutrient foramen is present, in 44 bone (i.e. 22.0%) double nutrient foramen is present and triple nutrient foramen was also observed in 9 bone (i.e. 4.5%)whereas in 4 bone (i.e. 2.0%) no nutrient foramen were noticied. It was also noticed that nutrient foramen in 173, 15 and 3 bones were observed at medial, lateral and posterior border respectively. According to the foraminal index 1(0.5%) bone comes under Zone I, 182(91%) in zone II and zone III consists of 13(6.5%) bone and average foramina index of bone is calculated as 56.18 and the average length of Humerus is calculated as 27cm. Pearson correlation is significant at the 0.05 level which is significant for bone having single, double and triple nutrient foramen. In the study the nutrient foramen of 98.47% (193) Humerus directed downward toward the distal end of bone whereas in 1.53% (3) of bone nutrient foramen is directed vertically downward and no nutrient foramen is directed upward toward the proximal end.
 Conclusions
 Most of the nutrient foramen of humerus follows as per rule where as some of the bone with no nutrient foramen were founded and our result support the former researchers too.

Study of nutrient foramina of human tibia of Saurashtra region

Introduction: On the shaft of tibia surface openings for entry of blood vasculature is known as nutrient foramen which leads to nutrient canal to provide a pathway for blood vessels to reach medullary cavity. Topographical information about nutrient foramen is very crucial during various orthopedic surgical procedures. Objective:Present study is conducted to find out the number of nutrient foramina, its location and direction in relation to growing end of bone and to calculate foraminal index of human tibia. Material and Methods:In present study 61(30 right and 31 left sided) tibia bone were studied. Age and sex of the bone were unknown. Only fully intact bone without any disease were included. Surface location and direction of nutrient foramina were recorded. Total length of tibia was measured with osteomatric board. Distance of nutrient foramen from proximal end was measured with digital vernier caliper. And foraminal index was calculated. All data was tabulated and analysed statisticaly. Result:Out of total 61 tibia 95.08% of tibia had one nutrient foramen, 3.28% tibia had two foramen and 1.64% were devoid of nutrient foramen. Almost all (98.33%) of the nutrient foramina were detected on the posterior surface, only 1.67% were on lateral surface. Zone I contained 48.33% and Zone II contained 51.67% of foramina. Not a single bone had foramen in Zone III. Direction of all foramina were towards lower end of tibia except one bone. Conclusion:Thorough knowledge of morphology of nutrient foramina is necessary for preserving the nutrient arterial blood supply. Because it is very crucial in bone grafting, fracture healing, joint replacement therapy and vascularised bone micro surgeries. Keywords:Tibia, Foraminal index, Nutrient foramen, Fracture, Morphometry.

A study on topography of clavicular neurovascular foramina and its surgical implications

Aim: To study the topography of clavicular nutrient foramina. Materials and Methods: The topography of nutrient foramina was studied in 71 clavicles. The mean foraminal index was calculated using Hughes formula. The direction of foramen was also observed. Results: The mean foraminal index was 36.31. The foramen was observed in the middle third of the clavicle in 87.32% cases and medial third in 12.68% cases. The foramen was observed in the inferior surface in 49.3% cases and posterior surface in 50.7% cases. No foramina were observed in the superior surface and in the lateral third of the clavicle. Conclusion: The foramina are mainly observed in the middle third of the clavicle. Standard literatures describe that foramen are mainly seen in the inferior surface but in our study, we observed foramina in both inferior and posterior surface in high frequency. This knowledge of distribution of foramina is of great importance for orthopaedic surgeons in surgeries like internal fixation and bone grafting. Keywords: Clavicle, Foraminal index, Periosteal vessels, Nutrient foramen, Surgical implications.

Anatomical study of nutrient foramina in humerus

Introduction: Knowledge of nutrient foramina is important in surgical procedures. Objective of present study is to know the number, location and direction of nutrient foramina in diaphysis of humerus and to test the significant difference of total length and foraminal index on right and left side separately. Materials and Methods: Total 100 dried humerii of unknown sex (52 of right and 48 of left side) were taken for present study. The identification of nutrient foramen was confirmed with the help of magnifying lens and metallic wire. The total length of humerus and distance of nutrient foramen from proximal end of humerus was measured by sliding caliper and osteometric board. Foraminal index was also calculated. Results: All the examined bones showed single diaphyseal nutrient foramen. Majority of foramina (81%) were present on middle 1/3 of anteromedial surface of shaft of humerus. The direction of these foramina was similarly found in all bones i.e. towards the elbow joint. There were no significant differences between right and left side for total length and foraminal index. Conclusion: An accurate knowledge of the location of nutrient foramina is important in surgical procedures like reduction of fracture, bone grafting and microsurgical vascularized bone transplantation. Keywords: Humerus, Nutrient foramina, Number, Location, Direction, Foraminal index.

A study of size of nutrient foramina of humerus of Gujarat region

Delayed union or non-union of fracture shaft humerus occurs if there is damage to nutrient artery of humerus during surgical procedure of open reduction of fracture or by displaced bone fragments of fracture or any soft tissue interposition. This implies vital role of nutrient artery of humerus in fracture healing. 200 human dried humeri were studied for its anatomy of size and number of nutrient foramina. Size of nutrient foramen and thereby size of nutrient artery was decided with use of hypodermic needle No. 20 G & No. 24 G from Eastern medikit Limited. Observations made were compiled and tabulated. In present study, out of 282 nutrient foramina, 98 (35%) were large sized. Single nutrient foramina were found on 63% of humerus which is indicative of single nutrient artery to humerus and amongst them 40% humerus having large sized nutrient foramina. 65% of large sized nutrient dominant foramina were found on humerus having more than one nutrient foramina. 60 (49%) large sized nutrient foramina were found on right side humerus which is points to more use of right arm. Orthopaedic surgeons treating opened or displaced fracture shaft humerus can very well prevent damage to nutrient artery of humerus with sound knowledge of size of nutrient foramina and thereby its artery and add to better prognosis of fracture healing.

Variation of the Nutrient Foramen of Fibula and its Clinical Significance

Background: The fibula is a long bone located at the lateral aspect of the leg. Its diaphysis is principally nourished by one or more nutrient arteries entering the shaft through an opening referred to as the nutrient foramen. The present findings on the morphometrics of the foramen may be helpful to forensic experts, radiologists and clinicians for diagnosis and management of various bony conditions.
 Materials and Methods: This was a descriptive cross sectional study conducted on fifty dry adult human fibulae collected at the Department of Anatomy, Chitwan Medical College from June to September 2020. Total fibular length along with the number and location of all nutrient foramina present were recorded. Foraminal index of the fibula was calculated as well.
 Results: The study revealed that the average length of Nepalese fibulae was 34.1 ± 1.9 cm. Eighty-eight percent fibula had a single nutrient foramen, 4 % had two and 8 % had none. The most common location was between the medial crest and posterior border (63%, in fibula with single foramen), followed by the medial crest (30%) and between the medial crest and interosseous border (7%). The average foraminal index was 44.01 ± 7.9 % with a range of 34.9 to 65.7 %.
 Conclusion: Single nutrient foramen located at the middle third on posterior aspect was the most common finding. Regional data on the number and location of the foramina would be useful to forensic experts and clinicians for various diagnostic and treatment purposes.

Anatomic study of the femur-vastus intermedius muscle-anterolateral thigh osteomyocutaneous free flap

Resection of head and neck malignancy usually causes facial defects and esthetic deformities. Among the wide range of free flaps available for reconstruction, a novel chimeric free flap-the femur-vastus intermedius muscle-anterolateral thigh osteomyocutaneous free flap (FVATLO flap)-has been demonstrated for clinical use. In this study, we illustrate the anatomy and harvest of the FVATLO flap. Eighteen fresh cadavers without damage to either thigh were recruited for dissection. Blood supply to the vastus intermedius muscle and femur were traced and recorded. The diameter, circumference of the middle part of the femur, and thickness of the femoral cortex were measured. The major blood supply to the vastus intermedius muscle showed two patterns of origin. The first arising from the descending branch of the lateral circumflex femoral artery (LCFA-db) accounts for 78% of the cases (28/36), and the second arising from the transverse branch of the lateral circumflex femoral artery (LCFA-tb) accounts for 22% (8/36). Blood supply to the femur consists of two major sources: one from branches penetrating through the nutrient foramen on the posteromedial surface of the femur to the medullary cavity, and the other from the periosteum branches spreading over on the femoral surface. No visible branch from the vastus intermedius muscle to the underlying periosteum was found. The mean diameter, femoral circumference, and mean cortical thickness were 26.30 mm, 85.58 mm, and 6.85 mm, respectively. Considering that there is only one injured donor site, the FVALTO flap is an alternative chimeric flap for cases with a large amount of soft tissue loss together with small bony defects.

CBCT INVESTIGATION OF THE INTRABONY CANAL COMMUNICATIONS BETWEEN THE VESTIBULAR AND LINGUAL PLATES IN THE ANTERIOR MANDIBLE

Purpose: To assess the presence of the vestibulo - lingual intrabony canal communications (VLC) in the anterior mandible using cone beam computed tomography (CBCT). Materials and methods: Study material included 200 CBCT scans taken for preoperative planning of implant placement. The images were examined carefully by three observers concerning the presence of VLC. Interobserver agreement in identification of the canal communications was excellent (mean kappa value – 0.82). Results: Vestibulo - lingual communications were found in 27 % of cases. The communications appeared as a crossing of the lateral lingual canal with the mandibular incisive canal (type 1), as a connection between midline lingual canal (or canals) and a vestibular nutrient canal (type 2) or as a lateral lingual canal connected with the anterior loop of the mandibular canal (type 3). The main type of VLC is those between a lateral lingual canal and mandibular incisive canal – 85.2% from all of the VLCs. Conclusions: A considerable part (27%) of Bulgarian citizens has vestibulo - lingual communications in the anterior mandible. The type 1 communication prevails, and it is more frequently located on the right side. The knowledge about vestibulo - lingual communications could contribute a better understanding of bone tumor invasion but further studies are necessary.

Prevalence of Nutrient Canals in Digital Radiographs With Correlation to Systemic Conditions

To determine if any correlation exists with incidence of nutrient canals in subjects with underlying systemic illness. 50 subjects were selected, which includes ten diabetic subjects, tenhypertensive subjects, ten post-menopausal women, ten periodontitis subjects,and ten subjects without any underlying systemic illness as control group.Radiovisiograph of all the patients was taken for evaluation of nutrient canals. Statistical analysis ofthe data was done using the statistical package for the social sciences (SPSS 16.0) using ANOVAanalysis. Differences were considered significant when P ≤ 0.05. Among50patients, 41 patientsshowed nutrient canals, whereas ninepatients didn’t show nutrient canals. Seven oftenpatients in Group I showed nutrient canals that accounts to 70% prevalence, eightof ten patients in Group IIshowed nutrient canals that account to 80% prevalence, and eightof ten patients in control group showednutrient canals that account to 80% prevalence and eight of ten patients in group V showed nutrient canals that account to 80% prevalence. Incidence of nutrient canals (NC) in the periapical radiograph can act as a supplemental diagnostic aid in detection of underlying systemic conditions like hypertension, diabetes mellitusand aiding the patient in his/her overall health and treatment planning

Estimation of sex from the metacarpal dimensions at the nutrient foramen in white South Africans

ABSTRACT Sex estimation is important in both forensic and archaeological cases and requires a variety of bones and measurements to obtain accurate estimates. Discriminant function analysis equations on postcranial elements are associated with population specificity, hence the need to generate equations for each population group. The current study examined the utility of the measurements around the nutrient foramen of the metacarpals for sex estimation from white South Africans. The study utilized 520 left metacarpals from 104 adult skeletons of white South Africans of known sex (53 males, 51 females) and age at death (range 21 to 65 years) obtained from the Raymond A. Dart Collection of Human Skeletons at the University of the Witwatersrand. Measurements that were subjected to stepwise and direct discriminant function analyses include total length, distance from proximal end to nutrient foramina, circumference, palmar-dorsal diameter, and mediolateral diameter at the level of the nutrient foramen. Combinations of breadth measurements of the first and second metacarpals produced high sex estimation scores ranging from 82% to 91% (stepwise discriminant function analysis) and 82–94% (direct discriminant function analysis) indicating that the dimensions around the nutrient foramen of the metacarpals are useful in sex estimation and can be used in fragmentary bones.

Study on the Nutrient Foramen of Long Bones of Lower Limb

Study on the Nutrient Foramen of Long Bones of Lower Limb

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

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.