|Year : 2012 | Volume
| Issue : 2 | Page : 76-80
A study of nutrient foramina in dry adult humeri of South Indian subjects
Manjunath S Halagatti1, Pramod Rangasubhe2
1 Assistant Professor of Anatomy, S. Nijalingappa Medical College, Bagalkot, Karnataka, India
2 Postgraduate student in Anatomy, JJM Medical Colelge, Davangere, Karnataka, India
|Date of Web Publication||23-Jan-2020|
Manjunath S Halagatti
Assistant Professor of Anatomy, S. Nijalingappa Medical College, Navanagar, Bagalkot, Karnataka - 587 102
Source of Support: None, Conflict of Interest: None
Background: Vascular insults to the humerus either during fracture dislocation or during surgical correction of fracture may result in delayed healing or non-union of fracture. It is worth to find the number and size of nutrient foramina. The knowledge regarding the nutrient foramina helps to protect them during conservative operative procedures of the bone, thus to concentrate upon the viability of the fractured fragments. Objectives: To observe the location of nutrient foramina with reference to the different segments of shaft of humerus, to note variations in number, direction and size of the nutrient foramina. Further to examine if a correlation exists between the length of humerus and number of vascular foramina and nutrient foramina. Materials and methods: The study was undertaken on 200 dry normal adult humerus bones. Observations were made using Hepburn’s osteometric board and hypodermic needles of different gauges. Statistical methods (SPSS) were used to analyze these observations. Results: The location of nutrient foramen was more in the middle l/3rd of antero- medial surface. Majority of humeri showed one nutrient foramen, whereas there were 2 to 3 foramina in few humeri. Conclusion: This study will help in planning the surgical treatment of fracture of humerus which will possibly reduce the post-operative complications.
Keywords: Humerus, Nutrient foramen, Nutrient artery, Fracture
|How to cite this article:|
Halagatti MS, Rangasubhe P. A study of nutrient foramina in dry adult humeri of South Indian subjects. Natl J Clin Anat 2012;1:76-80
|How to cite this URL:|
Halagatti MS, Rangasubhe P. A study of nutrient foramina in dry adult humeri of South Indian subjects. Natl J Clin Anat [serial online] 2012 [cited 2021 Jan 22];1:76-80. Available from: http://www.njca.info/text.asp?2012/1/2/76/298010
| Introduction|| |
The long strong humerus is a mobile strut - the first in a series of two - used to position the hand at a height and distance from the trunk to maximize its efficiency. Similar to a typical long bone it is fed by four groups of arterial systems, which are - a nutrient artery, epiphyseal, diaphyseal and periosteal arteries. It is worth to find the number and size of nutrient foramina. The nutrient artery, usually a branch of brachial artery, enters the nutrient foramen and is the major source of blood for the shaft of the humerus. The nutrient artery to the humerus enters usually through a restricted surface area beginning on the medial side of the distal third and spiralling proximally and medially to the dorsal surface of the middle third of the shaft. Any damage in this area, iatrogenic or traumatic may result in delayed healing or non-union.The knowledge regarding the nutrient foramen helps to protect them during conservative operative procedures of the bone, thus to concentrate upon the viability of the fractured fragments.
| Objectives|| |
- To observe the location of nutrient foramen in the different segments of shaft of humerus.
- To note variations in number, location, direction and size of the nutrient foramina.
- To establish if a correlation exists between the length of humerus and number of vascular foramina and nutrient foramina.
| Materials and Methods|| |
The present study was undertaken on 200 dry normal adult humerus bones of unknown sex (100 each of right and left sides).
The humeri were numbered using a marker pen. Using Hepburn’s Osteometric board, length of the bone was measured and size of the foramina was assessed using 19,22 and 25 gauge hypodermic needles. [Figure 1].
|Figure 1: Materials used in the study. A. Hepburn’s Osteometric board ; B. Other materials used (marker pen and hypodermic needles of different gauges).|
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Shaft of the humerus was divided into following segments - Upper l/3rd, middle l/3rd and lower l/3rd. Each third of the shaft was further observed under following surfaces - anteromedial surface, anterolateral surface and posterior surface.
The nutrient foramina observed in each of these segments were counted and they were categorized into three groups of sizes on the basis of gauge of the needle they admitted i.e., small - those which admitted 25 gauge needle (0.5 to 0.7mm), medium-those which admitted 22 gauge needle (0.71mm to 1.00 mm) and large- which admitted 19 gauge needle (>1.10mm).
The direction of nutrient foramina was also noted and categorized into three types - Horizontal (H), Upper oblique (UO) and Lower oblique (LO). Its location on the surface of humerus was also observed. Statistical methods (SPSS) were used to analyse these observations.
| Results|| |
As the results are shown in [Table 1] to [Table 2], [Table 3], [Table 4], among the total 200 humeri studied, 80% bones had one nutrient foramen, 18% had two and 2% had 3 nutrient foramina. [Figure 2]. 81% of the nutrient foramina were large sized and 19% were of medium size. 87% of the nutrient foramina were located in anteromedial surface and 9% in posterior and 4% in anterolateral surfaces. Majority of the nutrient foramina were in the middle third of the shaft (87%). Whereas upper l/3rd did not show any nutrient foramina. No correlation could be demonstrated between length and the number of nutrient foramina in the present study [Table 5].
|Figure 2: Humeri showing nutrient foramina, a - with two nutrient foramina; b - with three nutrient foramina.|
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| Discussion:|| |
Being the largest of the upper limb bones, humerus enjoys highest vascularity among these bones, deriving its nutrition from different arterial sources of upper limb. Blood supply is accomplished via various branches of axillary artery, brachial artery, radial and ulnar arteries, and quantum of blood supply by each is determined by the number and calibre of these arteries.
Inner half of the cortex and the medulla are vascularized by the nutrient artery, and it should be intact for the active repair of injuries. Outer half of the cortex is nourished by the periosteal vessels, and these vessels, do not provide an effective collateral supply of the medulla of the diaphysis. As far as shaft is concerned, nutrient vessels are the most important, followed by metaphyseal and then the periosteal vessels. The anatomical and physiological study of blood supply of diaphysis will aid in dealing with problems like nonunion, delayed union, bone transplants, etc.
Payton studied the position of the nutrient foramen and direction of the nutrient canal in the long bones of the madder-fed pigs. The varied growth of the humerus contributes to the direction of the nutrient foramen. The nutrient foramen is sandwiched between the two edges of new bone - one, the distal edge of new bone added to the shaft, and the other, proximal edge of new bone added to the olecranon fossa.
A constant nutrient foramen was observed in all the humeri just below the deltoid insertion, on the medial supracondylar ridge, a little below the midpoint of the shaft and was directed towards the elbow. Laing studied the arterial supply of adult humerus. He opined that the main nutrient artery to the humerus should be guarded against injury in operations on the humeral shaft.
The nutrient artery, a branch of the brachial artery, enters the shaft medially near the insertion of the coracobrachialis tendon, thus exposing itself to damage with some distal shaft fractures or internal fixation and a possible predisposition to non-union in the fractures of the middle or distal thirds.
The arteries which supply the shaft are mainly the nutrient arteries. In the present study, the density of nutrient foramina was observed in the middle l/3rd of the anteromedial surface. The size of the majority of nutrient foramina (81 %) in the present study was larger. This suggests the importance and critical role of nutrient artery in vascularization of long bones. The direction of all the nutrient foramina was towards the elbow, which is in accordance with the general rule of direction of nutrient foramina.
Carroll stated that nutrient artery to the humerus enters usually through a restricted surface area, on the medial side of the middle l/3rd of the shaft. Our observations are in complete acceptance with those by Carroll, as in this study we found 87% of nutrient foramina in anteromedial surface and 84% in the middle l/3rd of the shaft. Thus the present study goes with Carroll’s suggestion that, the area of location of nutrient foramina should be handled with care during surgeries, as damage to nutrient artery may result in delayed healing or rarely non union of fractures.
Majority of humeri (161) showed one nutrient foramen, whereas in 35 humeri there were 2 nutrient foramina and four humerii showed three nutrient foramina. This observation in our study shares a common view with Mysorekar that the diaphyseal nutrient foramina in humerus often two in number may show reciprocity in size. One of them would be the main nutrient foramen and the other, the accessory one. Common observation on location of nutrient foramen was that it is in the middle l/3rd of humerus where the nutrient artery may be torn during fracture at midshaft or fracture at middle l/3rd of humerus, resulting in alarming haemorrhage and depriving the humeral shaft of its main arterial source, thus highlights applied significance.
The number of nutrient foramina did not show any relationship to the length of the humerus in our study. Chhatrapati studied the position of nutrient foramen on 125 humeri. He had concluded that position and number of nutrient foramina on shafts of long bones are variable. A single bone may have more than one nutrient foramen. But it is not possible to find the total length of a long bone in relation to the position of nutrient foramen. The present study is in full agreement to that of Chhatrapati’s study, as correlation was not observed between number and location of nutrient foramen and the length of humerus.
The nutrient artery enters the bone during early development, and as the bone grows, the nutrient canal in which it lies usually has its external end carried toward the faster growing end. In most long bones, growth in length of the bone occurs much more at one end than at the other; thus, the slant of the canal from surface to marrow cavity is commonly towards the end that has grown less rapidly. The direction of nutrient foramen in this study was consistent toward the lower end i.e., lower oblique.
| Conclusion|| |
The present study conducted on vascular foramina of 200 dry adult humeri arrived at a conclusion that the location of nutrient foramen was more in the middle l/3rd of anteromedial surface. This location is highly significant, as the nutrient artery may be involved in iatrogenic or traumatic injuries. As the nutrient artery is the major source for the medullary wall and bone marrow, its zone over the shaft should be tackled with utmost care during surgical interventions for fractures in the middle l/3rd of humerus. In the present study there was no increase in number of nutrient foramina with increase in length of the humerus. The location of nutrient foramen is also inconsistent to arrive at particular relation between length of humerus and location of nutrient foramen.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]