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Original Article
MORPHOMETRIC STUDY OF THE NUTRIENT FORAMINA OF UNKNOWN RADIUS AND ULNA
AND THEIR CLINICAL IMPORTANCE IN THE REGION OF KADAPA [RAYALASEEMA],
ANDHRA PRADESH
Guthi Reddy Manoj Kumar Reddy1, C. Siddaramulu2, Arun Kumar S. Bilodi3
1Assistant
Professor, Department of Anatomy, Dr. NTR UHS, Vijayawada, Andhra Pradesh.
Professor, Department of Anatomy, Dr. NTR UHS, Vijayawada, Andhra Pradesh.
3Professor, Department of Anatomy, Dr. MGR University, Tamilnadu.
2Associate
ABSTRACT
AIM OF THE STUDY
The aim of the present study is to determine the number, direction of nutrient foramina in human bones of forearm and to
determine the most common location of nutrient foramina of bones in the forearm and to calculate the foramen index (FI) of
the bones of the forearm.
PLACE OF THE STUDY
This study was done in the Department of Anatomy of Rajiv Gandhi Institute of Medical Sciences[RIMS], Kadapa, Andhra
Pradesh.
PERIOD OF STUDY
This study was conducted during the month of September-October 2015 (Two months study).
MATERIALS AND METHODS
One hundred and four unknown dry human forearm bones namely radius and ulna constituted the materials for the present
study. These bones were studied [radii 54 (28Lt+26Rt), ulnae 50 (28Lt+22Rt)] from the Dept. of Anatomy of Rajiv Gandhi
Institute of Medical Sciences, Kadapa. Andhra Pradesh. Each bone was studied for the presence of nutrient foramina, their
number, location and the direction were carefully studied and recorded in various tables.
RESULTS
Twenty eight radii of the left side were studied. A single nutrient foramen was present in 27 bones, double nutrient foramina
seen in only one bone (Specimen No. 20), (Figure No. 1). Nutrient foramina were present on the anterior surface in 26 bones
(Figure No. 2), and in two bones they were seen on the interosseous border (Specimen Nos. 6 and 14), (Figure No. 3). Twenty
six radii of the right side were studied. A single nutrient foramen was present in twenty five bones, double NF seen in one
bone. (Specimen No. 10). Nutrient foramen was present on the anterior surface in twenty three bones and in two bones, they
were present on the interosseous border (Specimen Nos. 14 and 19) and in one bone on the posterior surface (Specimen No.
15), (Figure No. 4). The mean length of radius on left side was 23.6 cm; mean distance of NF from proximal end of bone was
7.8 cm. (Figure Nos. 8 and 9). The mean length of radius on right side was 24.6 cm; mean distance of nutrient foramen from
proximal end of bone was 8.2 cm.
Among 28 ulnae studied on the left side, single NF was present in all 28 bones. NF was present on the anterior surface in
26 bones, (Figure No. 5), on the interosseous border in one bone (Specimen No. 15), (Figure No. 6) and on the anterior border
in one bone (Specimen No. 27), (Figure No. 7). Among 22 ulnae studied on the right side, single NF was present in all 22
bones. NF was present on the anterior surface in 21 bones, on the interosseous border in 1 bone (Specimen No. 19).
CONCLUSION
This study on nutrient foramen has profound clinical surgical importance, hence studied and reported.
KEYWORDS
Long Bones, Bones of Forearm, Radius, Ulna Nutrient Arteries, Diaphysis, Nutrient Foramen.
HOW TO CITE THIS ARTICLE: Reddy GRMK, Siddaramulu C, Bilodi AKS. Morphometric study of the nutrient foramina of
unknown radius and ulna and their clinical importance in the region of Kadapa [Rayalaseema], Andhra Pradesh. J. Evid. Based
Med. Healthc. 2016; 3(27), 1222-1229. DOI: 10.18410/jebmh/2016/282
Financial or Other, Competing Interest: None.
Submission 04-03-2016, Peer Review 18-03-2016,
Acceptance 26-03-2016, Published 02-04-2016.
Corresponding Author:
Dr. Guthi Reddy Manoj Kumar Reddy,
Assistant Professor, Department of Anatomy, RIMS Medical
College, Putlampalli, Kadapa-516002, Andhra Pradesh.
E-mail: [email protected]
DOI: 10.18410/jebmh/2016/282
INTRODUCTION: Blood supply to the long bones in human
body is by nutrient arteries, epiphyseal arteries,
metaphyseal arteries and periosteal arteries. Among these
arteries, nutrient arteries play a major role by supplying
inner 2/3rd of cortex and whole medulla of the diaphysis.[1][2]
The blood supply of the long bone is particularly more
important in the early phases of ossification which takes
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Original Article
place in the active growth period of the embryo and
foetus.[3] In the early postnatal period, nutrient arteries
provide 70-80% of interosseous blood supply, which when
compromised can lead to medullary ischemia, reduced
vascularity of metaphysis and growth plate abnormalities.[4]
The point of entry of nutrient artery (NA) into the long bone
is indicated by the nutrient foramen (NF). The direction of
the nutrient foramen is determined by the growing end of
the bone. The growing end of the bone grows at least twice
as fast as the non-growing end. This is the reason for the
nutrient vessels to move away from the growing end of the
bone.[5] The direction of NF follows the dictum “to the elbow
I go and away from the knee I flee”.[2] In radius and ulna,
nutrient artery is a branch of anterior interosseous artery (a
branch of ulnar artery). Nutrient foramen is usually single,
located on the anterior surface, near the proximal end of the
bone and is directed proximally towards the elbow. [1] At
times, there may be more than one nutrient foramen and
the nutrient foramen may be found on the interosseous
border (or) lateral surface (or) on the posterior surface (or)
rarely on the anterior border.
MATERIALS AND METHODS: One hundred and four
unknown dry human both bones of forearm that is radius
and ulna were selected for the study of nutrient foramina.
Their number, location and direction were studied in all one
hundred and four bones. Among them radii were fifty four
[twenty eight of the left side and twenty six of right side]and
that of ulna they were fifty bones [of twenty eight on the
left side and twenty two on the right side] from the. The
study was conducted in the Department of Anatomy at Rajiv
Gandhi Institute of Medical Sciences, Kadapa, Andhra
Pradesh. All the bones were studied for the number of NF
and location of NF. The total length of each bone and
distance of NF from the proximal end of the bone is
measured using osteometric board. The observations made
were tabulated and the Foramen Index was calculated using
HUGH’s Formula.[6]
According to HUGH’S Formula,
OBSERVATIONS: The observations made regarding the number and location of nutrient foramina of radii are tabulated as
follows:
Sl. No.
1.
2.
3.
Left side
Number of NF
1
1
1
Location of NF
Anterior surface
Anterior surface
Anterior surface
4.
5.
6.
7.
8.
9.
1
1
1
1
1
1
Anterior surface
Anterior surface
Interosseous border
Anterior surface
Anterior surface
Anterior surface
10.
1
11.
12.
13.
14.
15.
16.
17.
18.
19.
1
1
1
1
1
1
1
1
1
20.
2
21.
22.
23.
24.
Sl. No.
1.
2.
3.
4.
Right side
Number of NF
1
1
1
Location of NF
Anterior surface
Anterior surface
Anterior surface
5.
6.
7.
8.
9.
1
1
1
1
1
1
Anterior surface
10.
2
11.
12.
13.
14.
15.
16.
17.
18.
19.
1
1
1
1
1
1
1
1
1
20.
1
Anterior surface
1
1
1
Anterior surface
Anterior surface
Anterior surface
Interosseous Border
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Interosseous Border
Posterior surface
Anterior surface
Anterior surface
Anterior surface
Interosseous Border
21.
22.
23.
1
1
1
Anterior surface
Anterior surface
Anterior surface
1
Anterior surface
24.
1
Anterior surface
J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 3/Issue 27/Apr. 04, 2016
Anterior
Anterior
Anterior
Anterior
Anterior
Anterior
surface
surface
surface
surface
surface
surface
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25.
26.
27.
28.
Original Article
1
1
1
1
Anterior
Anterior
Anterior
Anterior
surface
surface
surface
surface
25.
26.
-
1
1
Anterior surface
Anterior surface
Table 1: Number and location of nutrient foramina for radius
Among 28 radii studied on the left side, single NF was
present in 27 bones, double NF is seen in one bone.
(Specimen No. 20), (Figure No. 1). NF was present on the
anterior surface in 26 bones (Figure No. 2), on the
interosseous border in 2 bones (Specimen Nos. 6 and 14),
(Figure No. 3).
Among 26 radii studied on the right side, single NF was
present in 25 bones, double NF is seen in one bone.
(Specimen No. 10). NF was present on the anterior surface
in 23 bones, on the interosseous border in 2 bones
(Specimen Nos. 14 and 19) and on the posterior surface in
one bone (Specimen No. 15), (Figure No. 4).
Left side
Right side
Sl. No.
Number of Nutrient
Foramina
Location of Nutrient
Foramina
Sl. No.
Number of Nutrient
Foramina
1.
2.
3.
4.
5.
6.
7.
1
1
1
1
1
1
1
Anterior
Anterior
Anterior
Anterior
Anterior
Anterior
Anterior
8.
9.
surface
surface
surface
surface
surface
surface
surface
1.
2.
3.
4.
5.
6.
7.
1
1
1
1
1
1
1
Anterior
Anterior
Anterior
Anterior
Anterior
Anterior
Anterior
1
Anterior surface
8.
1
Anterior surface
1
Anterior surface
9.
1
Anterior surface
10.
1
Anterior surface
10.
1
Anterior surface
11.
1
Anterior surface
11.
1
Anterior surface
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Location of Nutrient
Foramina
surface
surface
surface
surface
surface
surface
surface
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Original Article
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
1
1
1
1
1
1
1
1
1
Anterior surface
Anterior surface
Anterior surface
Interosseous Border
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
1
1
1
Anterior surface
Anterior surface
Anterior surface
24.
1
Anterior surface
25.
26.
27.
28.
1
1
1
1
Anterior surface
Anterior surface
Anterior border
Anterior surface
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
-
1
1
1
1
1
1
1
1
1
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Anterior surface
Interosseous Border
Anterior surface
1
1
-
Anterior surface
Anterior surface
Table 2: Number and location of NF for ulna
Among 28 ulnae studied on the left side, single NF was
present in all 28 bones. NF was present on the anterior
surface in 26 bones, (Figure No. 5), on the interosseous
border in one bone (Specimen No. 15), (Figure No. 6) and
on the anterior border in one bone (Specimen No. 27),
(Figure No. 7).
Among 22 ulnae studied on the right side, single NF was
present in all 22 bones. NF was present on the anterior
surface in 21 bones, on the interosseous border in 1 bones
(Specimen No. 19).
Sl. No.
1.
2.
3.
4.
5.
6.
Left side
Distance of the Nutrient
Length of the
Foramina (From proximal
Bone (cm)
end of Bone) [cm]
23.5
8
23
8
24
7.5
23
8
25
7
24
8.5
Sl. No.
1.
2.
3.
4.
5.
6.
Right side
Distance of the Nutrient
Length of the
Foramina (From proximal
Bone (cm)
end of Bone) [cm]
24
8.5
24
9
24
7.5
23
8
25
7.5
24
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8.5
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7.
8.
9.
23.5
24
8
7
23
24
7.5
9
9
7.
8.
9.
24.5
24.5
24
7
10.
25
24
23
23
8.5
7.5
8
11.
12.
13.
25.5
24
23
7
7.5
6
8.5
8.5
8
10.
11.
12.
13.
14.
24
8
15.
16.
17.
18.
19.
23.5
24
25
23
24
8
8
7
8.5
8
14.
24
9
15.
16.
17.
18.
19.
23.5
24
24
23
25
20.
24
20.
25
7
21.
22.
23.
23
24
24
9.5
8.5
7
7.5
9
8
6.5
8
8.5
9
21.
22.
23.
23
24
24.5
9
7
8.5
24.
25
8
24.
23.5
7.5
25.
26.
27.
28.
Mean
Foramen
Index
25
24
23
23.5
23.6
7
8
7.5
8
7.8
25.
26.
Mean
Foramen
Index
24
25
24.6
8
9.5
ss8.2
33.05
33.33
Table 3: Length, distance of NF from proximal end and foramen index of radius
The mean length of radius on left side was 23.6 cm;
mean distance of NF from proximal end of bone was 7.8 cm.
(Figure Nos. 8 and 9).
The mean length of radius on right side was 24.6 cm;
mean distance of NF from proximal end of bone was 8.2 cm.
Left side
Right side
Sl. No.
Length of
bone (in cm)
Distance of NF
(from proximal end of bone)
Sl. No.
Length of
bone (in cm)
Distance of NF
(from proximal end of bone)
1.
2.
3.
4.
5.
24.5
23
24
24
25
9
9
7
9
7
1.
2.
3.
4.
5.
23.5
24
23
25
24.5
9
8.5
7
7
9
6.
25
8.5
6.
24
9
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Original Article
23.5
24
9
9
10.
11.
12.
13.
25
24
25
24
24
9
7.5
9
9
9
14.
24.5
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.5
24.5
24
24
25
24
24
24
24
24.
25
9
25.
26.
27.
28.
Mean
Foramen
Index
25
24
25
23.5
24.3
8
8
9.5
9
8.6
7.
8.
9.
24
25
8
7
10.
11.
12.
13.
24.5
24
25.5
25
28.5
9
9
8
8
10.5
9
14.
23
9
9
8.5
7
7
9
9
8
9.5
9
15.
16.
17.
18.
19.
20.
21.
22.
24
24
24
23.5
24.5
23
24
25.5
9
9
7
9
7
8.5
9
9
Mean
Foramen
Index
24
8.4
7.
8.
9.
35.4
35
Table 4: Length, distance of NF from proximal end and foramen index of ulna
The mean length of ulna on left side was 24.3 cm; mean
distance of NF from proximal end of bone was 8.6 cm.
(Figure Nos. 10 and 11).
The mean length of ulna on right side was 24 cm; mean
distance of NF from proximal end of bone was 8.4 cm.
RESULTS: The following table shows the results regarding
the number and location of NF and Foramen Index of the
human forearm bones.
Left side
Radius
Right
side
Total
Left side
Ulna
Right
side
Total
Total number of bones studied
28
26
54
28
22
50
No. of bones with single NF
27(96.4%)
25(96.2%)
52(96.3%)
28(100%)
22(100%)
50(100%)
No. of bones with double NF
01(3.6%)
01(3.8%)
02(3.7%)
00
00
00
No. of bones with NF on Anterior surface
26(92.8%)
23(88.6%)
49(90.7%)
26(92.8%)
21(95.5%)
47(94%)
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Original Article
No. of bones with NF on Interosseous
border
02(7.2%)
02(7.6%)
04(7.4%)
01(3.6%)
01(4.5%)
02(04%)
No. of bones with NF on Posterior surface
00
01(3.8%)
01(1.9%)
00
00
00
No. of bones with
00
00
00
01(3.6%)
00
01(02%)
Foramen Index
33.05
33.34
33.2
35.4
35
35.2
Table 5: Number of NF, location of NF and foramen index of the human forearm bones
Among the total number of radii studied 96.3% of bones
showed single NF, 3.7% showed double NF. NF was present
on anterior surface in 90.7% of bones, on interosseous
border in 7.4% of bones and on Posterior surface in 1.8%
of bones. Foramen index is 33.2.
Among the total number of Ulnae studied all bones
showed single NF. NF was present on anterior surface in
94% of bones, on interosseous border in 4% of bones and
on anterior border in 2% of bones. Foramen index is 35.2.
COMPARISON WITH PREVIOUS STUDIES:
Double NF
NF on
Anterior
surface
NF on
Interosseous
border
NF on
Posterior
surface
Single NF
Double NF
NF on
Anterior
surface
NF on
Posterior
surface
NF on
Anterior
border
Present study
96.3
3.7
90.7
7.4
1.9
100
-
94
4
2
Ojaswini et al[5]
Ukoha Ukoha et
al[7]
Bichitrananda et
al[8]
Ulna
Single NF
Radius
68
97.29
2.7
Pereira et al[9]
99.4
0.6
Satish M Patel et
al[10]
100
94.3
-
5.6
91.4
-
8.6
78
98.9
-
-
100
-
-
100
73.2
87.5
12.5
98.6
1.4
82.2
92.5
7.5
100
Table 6: Comparison with previous studies
DISCUSSION: In the present study, 96.3% of radii showed
single NF and 3.7% showed double NF. These findings were
similar to those made by Bichitrananda et al,[8] Pereira et
al,[9] and differs with the observations made by Ukoha Ukoha
et al.[7] NF was present on anterior surface of radius in
90.7% of bones, these observations are close to those
observations made by Ojaswini et al,[5] Ukoha Ukoha et al[7]
and differs from those observations made by Pereira et al,[9]
Satish M Patel et al.[10] Nutrient Foramina were present on
the posterior surface in 1.8% of bones, these findings differ
from those recorded by Ojaswini et al,[5] Ukoha Ukoha et
al[7] and Satish M Patel et al.[10] Mean Foramen index is 33.2
indicating that the NF is located in the upper third of bone.
In the present study, all ulnae showed single NF and
this finding was similar to those observations made by
Bichitrananda et al,[8] while Ukoha Ukoha et al,[7] Pereira et
al,[9] Satish M Patel et al[10] could locate the presence of
double NF in Ulna. Nutrient foramina were present on
anterior surface in 94% of bones, close to the findings of
Ojaswini et al.[5] Mean Foramen Index is 35.2 indicating that
the nutrient foramina was located in the middle third of
bone.
CONCLUSION: The vascular system of the long bones
plays key role in the development of some pathological bone
conditions like congenital pseudoarthrosis,[11] Acute and
haematogenous osteomyelitis, healing of long bone
fractures.[12]
The knowledge of the variations occurring in the blood
supply of the long bones is important in the development of
new transplantation and resection techniques in
orthopaedics,[3][13]
reconstructive
surgeries,[14]
[15][16]
microvascular bone graft procedures.
In transplant techniques, the use of statistical data on
the nutrient foramina distribution in long bones makes it
possible for the professional to select the osseous section
levels of the receptor in order to place the graft without
damaging the nutrient arteries, preserving, thus, the
diaphyseal
vascularisation
and
the
transplant
consolidation.[17]
In free vascular bone grafting procedures, the nutrient
artery blood supply is of utmost importance and must be
preserved to promote fracture repair, for osteoblast and
osteocyte cell survival, facilitating graft healing in the
recipient.[18][19]
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An accurate knowledge of the location of the nutrient
foramina in long bones would help in preventing
intraoperative injuries in orthopaedic as well as in plastic and
reconstructive surgery. Placement of internal fixation
devices can be appropriately done with the knowledge of
variations in the nutrient foramen.[20]
Take home message: This study give us the knowledge of
location of nutrient artery so as to preserve these nutrient
arteries during surgery in case of fractures bones.
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