|Year : 2021 | Volume
| Issue : 2 | Page : 93-96
An anatomical study of vascular foramina of radius and its clinical insinuation
Pramod Pundalik Rangasubhe1, PS Bhusaraddi2, Pratik Pradeep Khona3, Pavan Prahlad Havaldar2
1 Associate Professor, Department of Anatomy, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
2 Professor, Department of Anatomy, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
3 Assistant Professor, Department of Anatomy, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
|Date of Submission||28-Oct-2020|
|Date of Decision||23-Dec-2020|
|Date of Acceptance||30-Jan-2021|
|Date of Web Publication||09-Apr-2021|
Pavan Prahlad Havaldar
Department of Anatomy, Gadag Institute of Medical Sciences, Mulgund Road, Mallasamudra, Gadag - 582 03, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Different segments of radius present numerous vascular foramina (VF). The objective of the study was to quantify VF and note their size and direction. Methodology: One hundred dry human radii bones in our anatomy department were divided into various segments for studying VF. The number and direction of VF were evaluated in upper end (UE), shaft, and lower end (LE) separately. VF were categorized into three groups based on size, namely small (which admitted 25-gauge needle): 0.5–0.7 mm, medium (22-gauge needle): 0.71 mm to 1.10 mm, and large (19-gauge needle): >1.10 mm. The direction of foramina in each segment was noted. They were categorized into three types: horizontal, upper oblique, and lower oblique. Results: Significantly, a greater number of VF in the UE of radius were observed in the neck (average: 9.3 foramina) than in the radial tuberosity (average: 1.3 foramina). In the shaft, the maximum number of VF was observed in the anterior surface and minimum was found in the lateral surface. In the LE, the maximum number of VF was observed in the posterior surface (average 7.2 foramina) and minimum was found in the medial surface (average 1.6 foramina). In the UE of radius, 81.8% of VF were small sized. In the UE of radius, 62.8% of VF were directed horizontally. In the shaft, almost all (99%) VF were directed upper oblique. Conclusion: The present study concludes that different segments of radius have different densities of VF. The LE of radius has got more VF compared to UE indicating its rich vascularity.
Keywords: Epiphyseal, fracture, periosteal, radius, vascular foramina
|How to cite this article:|
Rangasubhe PP, Bhusaraddi P S, Khona PP, Havaldar PP. An anatomical study of vascular foramina of radius and its clinical insinuation. Natl J Clin Anat 2021;10:93-6
|How to cite this URL:|
Rangasubhe PP, Bhusaraddi P S, Khona PP, Havaldar PP. An anatomical study of vascular foramina of radius and its clinical insinuation. Natl J Clin Anat [serial online] 2021 [cited 2021 Sep 20];10:93-6. Available from: http://www.njca.info/text.asp?2021/10/2/93/313515
| Introduction|| |
Four sets of blood vessels, namely nutrient artery, juxta-epiphyseal or metaphyseal, and epiphyseal and periosteal arteries supply typical long bones. The radius being the long bone receives nutrition via the above-said arteries. Different segments of radius present numerous foramina through which arteries supplying it will enter, such foramina are named vascular foramina (VF). Nutrient foramen is one of the important diaphyseal VF as nutrient artery enters the shaft of radius through this foramina. In the present study, we are focusing on VF excluding the diaphyseal nutrient foramina.
A large number of unnamed nutrient arteries traverse the ends of long bones and are obviously important for growth and maintenance. The foramina through which these vessels pass are both numerous and constant and are more conspicuous than the one or two diaphyseal nutrient foramina in the shaft. Exact information about the VF is essential for an understanding of the arterial supply of the bone.
The posterolateral periosteum around the neck region of the radius is one of the key areas penetrated by blood vessels supplying the radial head. During open reduction and internal fixation procedures related to fracture of radial head and neck, periosteal attachment preservation is important. One of the common complications after fracture of the radial head is avascular necrosis due to the lack of blood supply to the displaced fragment. Radius bone segments are commonly used as bone graft. A common source of vascularized bone graft for scaphoid nonunion or Kienbock's disease is distal dorsal radius which has an abundant blood supply.
The precise knowledge of VF is very much essential to harvest osteocutaneous radial forearm free flap which is the common source for reconstruction surgeries in the head-and-neck region. The tuberosity of radius along with the proximal one-fourth receives their blood supply by the branches of common and recurrent interosseous artery along with ulnar artery.,, The branches arising from the anastomotic network between radial recurrent and radial collateral arteries feed radial head and neck extraosseously. Radial neck in addition also receives branches arising from anastomotic network between interosseous recurrent and middle collateral arteries. The supply of blood to the intraosseous part of the radial head and neck is by branches arising from radial recurrent and interosseous recurrent arteries. There is a double blood supply to the radial head, one is a branch of the radial recurrent artery and other perforates the capsular insertion around the radial neck which is a vessel from radial and interosseous recurrent arteries.
Anterior interosseous artery through its periosteal branches supplies the distal three-fourth of the radius. The connecting branch between the anterior interosseous artery and dorsal carpal arch supplies the dorsal metaphyseal region of the distal radius. Multiple metaphyseal nutrient arteries are intercompartmental vessels which originate from the radial and anterior interosseous arteries. A network of fascioperiosteal and musculoperiosteal vessels supply the bone via septal and muscular attachments.
Recent studies on vascularity of radii bones concentrate only on diaphyseal nutrient foramina. The size, site, and number of other VF are worth studying as well. There are not much available data concerning the exact location and entrance of vessels through VF. During operative procedures, this knowledge regarding the VF helps to conserve the fractured segments by keeping their blood supply intact.
The objectives of the present study were to study the site and distribution of VF in different segments of radius, to quantify the number of the VF, to measure the size of the VF, and to observe the direction of the vascular VF.
| Methodology|| |
In an observational study, 100 dry adult human radii bones, 50 belonging to the right and 50 belonging to the left side, from our anatomy department were evaluated for VF. Since cadaveric bones were used ethical clearence was not taken. Each radius was divided into various segments for studying VF.
Inclusion and exclusion criteria
Dry, clean, and anatomically, and pathologically normal human radii bones were taken. Only well-defined VF were observed. VF only were included in the study.
damaged bones or any fractured bones or bones with any other pathological changes were excluded from our study.
Race, age, and sex were not studied as observed bones were taken from osteology collection of dry bones and not from the cadavers. Nutrient foramina were excluded from the study.
The number and direction of VF were evaluated in the upper end (UE), shaft (S), and lower end (LE) separately. UE is divided into neck (N) and radial tuberosuty. Shaft (S) was divided into anterior surface, posterior surface, and lateral surface. LE (L) was divided into anterior surface, posterior surface, medial surface, and lateral surface.
The number of VF in each of these segments was counted. The size was noted using 19, 22, and 25 gauge hypodermic needles. VF were categorized into three groups based on size, namely small (which admitted 25 gauge needle): 0.5–0.7 mm, medium (22 gauge needle): 0.71 mm to 1.10 mm, and large (19 gauge needle): >1.10 mm., The direction of foramina in each segment was noted. They were categorized into three types: horizontal, upper oblique, and lower oblique.
All numerical data were tabulated and expressed as mean and standard deviation.
SPSS software, version 26, IBM Corporation (SPSS Inc., USA) was used to analyze the above said parameters.
| Results|| |
Location and number of vascular foramina
Significantly, more number of VF in the UE of radius was observed in the neck (average 9.3 foramina) than in the radial tuberosity (average 1.3 foramina) [Figure 1] and [Table 1]. In the shaft, the maximum number of VF was observed in the anterior surface and minimum was found in the lateral surface [Table 2]. In the LE maximum number of VF was observed in the posterior surface (average 7.2 foramina) and minimum was found in the medial surface (average 1.6 foramina) [Figure 2] and [Table 3]. LE of radius (average: 15.5 foramina) has significantly more number of VF than the UE (average number: 10.6 foramina) [Table 4].
|Table 1: Location, size, and direction of all vascular foramina in the upper end of 100 radii|
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|Table 2: Location, size, and direction of vascular foramina in the shaft of 100 radii|
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|Table 3: Location, size, and direction of vascular foramina in the lower end of 100 radii|
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|Table 4: Total number of vascular foramina in different segments of 100 radii|
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Size of vascular foramina
In the UE of radius, 81.8% of VF were small sized and rest were medium sized [Table 1]. In the shaft, 74% of VF were medium sized [Table 2]. In the LE of radius, 73.8% of VF were small sized [Table 3].
Direction of vascular foramina
In the UE of radius, 62.8% VF were directed horizontally [Table 1]. In the shaft, almost all (99%) VF were directed upper oblique [Table 2]. In the LE of radius, 78.4% of VF were directed horizontally in posterior, medial, and lateral surfaces. In the anterior surface, 68.4% of VF were directed lower oblique [Table 3].
| Discussion|| |
Bone is well supplied with blood vessels which ramify freely in the periosteum and in the case of the shafts of long bones by vessels in the medullary cavity. Impairment of circulation by interruption of some of the vessels, as a result of injury or fracture may lead to necrosis and interfere in the healing of fractures, thus bony union may be delayed. For this reason, it is of great practical importance that the mode of vascularization of bones should be well understood by the orthopedic surgeon. Distributions of VF at the ends of long bones follow a fairly specific pattern. Numerous VF penetrate bones near their ends, often at fairly specific sites. Some are occupied by arteries but most contain thin-walled veins. The epiphysial and metaphyseal arterial supply is richer than the diaphyseal supply. The vessels in the periosteum supply the outer one-third of the cortex. The metaphyseal branches alone were not capable of maintaining the demands of the inner half of the cortex and marrow. In an evaluation of nutrient foramina of radius among south Indian subjects, Rangasubhe and Shivan have reported medium-sized foramen in the shaft of the radius directed upward. The vascularity of the shaft is not affected by simple division of nutrient artery as compensatory circulation sets in via periosteal vessels in young and metaphyseal–epiphyseal vessel network in adult.
The ends of the typical long bones have several arteries and veins traversing; hence, numerous VF are usually seen close to the proximities of dried bones. Various studies on epiphyseal network of vessels in the UE of radius revealed that the first collateral of the ulnar artery along with recurrent radial artery formed the epiphyseo-metaphyseal network which was the main extraosseous supply to the radius. From this network, mainly three intra-epiphyseal branches originated which traversed through the head. The main blood supply to the distal part of radius is through palmar epiphyseal vessels (branches from radial, palmar carpal arch and anterior branch of anterior interosseous artery), anterior interosseous artery (periosteal and cortical branches), and dorsal epiphyseal vessels. This network of arteries in the distal segment of radius makes a fundamental part during the healing of fractures of the distal segment making nonunion a rare complication.
Radial osteocutaneous forearm flap is most commonly used in reconstruction of mandible and mid-face. Patients are selected based on the tests to confirm viability of the hand and digits with ulnar arterial alone. As the radial artery vascular pedicle is long, this flap procedure is advantageous over other donor sites. However, the operated side will have reduced forearm and wrist strength and osteotomized bone is at risk of fracture. Studies have shown that the dorsal segment of radius can be used as grafts for scaphoid nonunions.
The present study shows that the VF are distributed in largely in LE. Most of the VF of the radius were of small size, whereas the maximum large-sized VF was found in LE. This is in agreement with Shin and Bishop who observed the copious blood supply of distal radius, which makes it a preferred source of bone graft.
Observation on the location of VF in the UE of radius showed no foramina in the head region with the maximum number in the neck compared to the radial tuberosity. This indicates that the radial head gets its blood supply from vessels penetrating the head–neck junction. Avascular necrosis of radial head though rare, can occur if there is any injury involving this junction.
The posterior surface of LE of radius showed maximum number of VF, followed by anterior, lateral, and medial surfaces. Hence, the distal part and posterior surface of radius has abundant blood supply through series of longitudinal vessels originating from the radial artery or anterior interosseous artery. Several authors have concluded that the dorsal radius graft can be harvested based on vessels from the anterior interosseous or radial artery.
| Conclusion|| |
The present study concludes that the different segments of radius have different densities of VF. The LE of the radius has got more VF compared to UE indicating its rich vascularity. The knowledge of number, site, and direction of VF of radii bones shall help surgeons in planning the procedures related to the radius (fractures, transplant segments).
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]