Long Bone Case Study

The Nutrient artery enters the shaft of long bone through Nutrient foramen and it traverses obliquely through the canal in the shaft. In tibia, nutrient foramen is directed towards distal end (Figure-1). It will supply the inner half of the cortex, metaphysis and the medullary cavity in the shaft of long bone. The tibia is weight bearing strong medial bone of the leg. Nutrient artery of tibia arises from either posterior tibial artery, anterior tibial artery or its branches at the level of the popliteal bifurcation (1, 2, 3). The position, size, direction, number and location of nutrient foramen are variable and may alter during the growth (4, 5). The vascular injury by traumatic reasons like fracture, bullet injury or by iatrogenic reasons

Large size- accepting the needle no-20 gauge (≥0.91mm),

2. Medium size- accepting the needle no-24 gauge (0.91mm > diameter ≥ 0.55mm),

3. Small size- which do not accept the needle no-24 gauge (diameter < 0.05 was considered significant. AB- anterior border, MB-medial border, LB/IOB-lateral border/ interosseous border,

MS-medial surface, PS-posterior surface, VL-vertical line and LS-lateral surface.

Figure-2, Different zones of tibia bone.

Result-

In the present study totally 126 nutrient foramina were observed, in which single nutrient foramina (Figure-1) was found in all the tibiae (100%). The incidence, size and distribution of nutrient foramina on the horizontal and vertical zones of tibial diaphysis were presented in Tables-1and 2.

Table-1. General findings of present study on nutrient foramina in tibial diaphysis.

- Findings Description Numbers Percent Total

1 Sample size (n=126) Right 63 - 126 Left 63 -

2 Total number Right 63 50% 126 Left 63 50%

3 Number -per bone One per bone 126 100% 126 Two per bone 0 0.0%

4 Frequency on horizontal zones. Upper 1/3rd 116 92.06 % 126 Middle 1/3rd 10 7.94% Lower 1/3rd 0 0.0%

5 Direction Towards proximal end 0 0.0%

The site of foramen and nutrient canal may be a weak point, which is prone for fracture (24, 25, 26). Any damage to the precise area of nutrient foramen or nutrient canal or nutrient artery by traumatic or iatrogenic reasons may result with delay in union or fracture healing or graft healing, because healing process is dependent on blood supply (9,10). By avoiding damage to this limited area of the cortex, better result and faster healing can be achieved. This descriptive study concurs and corroborates well with previous study