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Rationale and Objectives: Blood supply is vital for sound callus formation. The tibial nutrient artery (TNA) is the main diaphyseal artery nurturing the tibial shaft. The objective is to investigate the impact of TNA canal (TNAC) injury on the development of atrophic, oligotrophic, and hypertrophic nonunion in patients with tibial shaft fractures., Materials and Methods: Between January 2010 and December 2020, patients with a nonunion of a tibial shaft fracture were retrospectively included. Two readers independently evaluated the integrity of the TNAC and classified nonunion type. A multinomial regression model was utilized to evaluate if a TNAC injury has an impact on the type of nonunion., Results: From an initial set of 385 patients with the diagnosis of a nonunion of the lower leg, a total of 60 patients could be finally included in the study. Most patients were males (78%), diabetic (95%), smokers (73%), and had an American Society of Anesthesiologists (ASA) score of 2 (72%). TNAC injury was noted in 24 patients (40%): an iatrogenic TNAC injury was observed in 13 (22%) patients, a traumatic TNAC injury in 11 (18%) patients. Most patients had a hypertrophic nonunion (29 patients (48%)), followed by an oligotrophic nonunion (24 patients (40%)) and lastly an atrophic nonunion (seven patients (11%)). The multinomial regression model showed that there was no impact of TNAC injury on the development of a specific type of non-union (p = 0.798 for oligotrophic vs. atrophic nonunion; p = 0.943 for hypertrophic vs. atrophic nonunion). Furthermore, patients were about four times more likely to develop an oligotrophic/hypertrophic nonunion rather than atrophic one (odds ratio 3.75 and 4.25, respectively), regardless of the presence of a TNAC injury., Conclusion: In the evaluated patient cohort with tibial shaft fractures, we could not find a statistically significant association between TNAC injury and type of nonunion. However, patients were almost four times more likely to develop oligotrophic or hypertrophic nonunion rather than an atrophic one although common risk factors for impaired (micro)vascular blood supply were highly prevalent in the study group. Multicenter studies with a larger number of atrophic nonunions are warranted to further evaluate this result., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Introduction:  Fracture or surgical intervention of fracture of the shaft of the humerus may cause injury to the nutrient artery leading to the nonunion or delayed union of the fracture. It is important to find the number and location of the nutrient artery. So the knowledge regarding the nutrient foramen helps to protect them during any operative procedure of the shaft of the humerus. The main objective of this study is to find out the number, location, and direction of the nutrient foramen of the humerus., Materials and Methods: The study was conducted on 80 dried humeri of unknown gender obtained from Narayan Medical College, Sasaram, Bihar, India, and also from other medical colleges of Bihar. The number, location, and direction of nutrient foramen were observed., Results: The majority of humeri showed one nutrient foramen, which was found in 91.25%, followed by 3.75% with double foramen and 1.25% with triple foramen. Nutrient foramen was absent in 3.75% of the humerus. The majority (89.02%) of nutrient foramen was found on the anteromedial surface followed by anterolateral (9.76%) and posterior surface (1.22%). The majority of nutrient foramen was found on the middle third (86.58%) of the shaft, followed by 13.42% on the distal third. No nutrient foramen was found on the proximal third of the humerus. All nutrient foramina were directed downward., Conclusion: The location of the nutrient foramen of the humerus was not constant; it may present on anteromedial, anterolateral, or posterior surfaces. Similarly, it may present on the middle or distal third of the shaft of the humerus. This study will help surgeons planning the surgical intervention of the shaft of the humerus, which will possibly reduce the chances of nonunion or delayed union., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kumar et al.)

Variations in vascular anatomy are of great concern to surgeons, as proper identification of aberrant arteries can reduce the risk of iatrogenic injury and improve patient outcomes. Several studies have highlighted the irregular branching pattern of pelvic arteries, with a recent focus on the obturator artery (OA). The OA has an inconstant origin from the internal iliac artery, external iliac artery, or inferior epigastric artery. Within the pelvis, the OA can give off muscular branches and nutrient vessels to the ilium and pubis. Though occasionally described in text, few resources employ images of human donors that depict branches arising from the OAs. Out of the 34 hemisected pelves studied, we identified 1 individual with a substantial nutrient vessel branching unilaterally from the OA. Herein, we present the first image of this unconventional nutrient artery. This vessel should be highlighted given that its size and course make it particularly vulnerable during intrapelvic surgeries such as pelvic lymph node dissection or in procedures requiring arterial embolization of the OA.

If arteries penetrate bones through foramina, regional artery blood flow rates can be estimated from the foramen sizes. Femoral bone blood flow rates estimated from nutrient foramen sizes were previously not absolute, but only a relative blood flow index (Q i ), because the size relationship between the foramen and the occupying artery was unknown. The current study used vascular contrast and micro-computerized tomographic scanning to investigate femoral nutrient foramen and nutrient artery sizes in three groups of sub-adult chickens (non-laying hens, laying hens, and roosters) of similar ages. The results indicate that the cross-sectional area of the nutrient artery lumen occupies approximately 20.2 ± 4.1% of the foramen for femora with only one foramen. Artery lumen size is significantly correlated with foramen size. Vascular contrast imaging is capable of estimating blood flow rates through nutrient arteries, as blood flow rates estimated from artery lumen casts are similar to blood flow rates measured by infusion of fluorescent-labeled microspheres. Laying hens tend to have higher nutrient artery perfusion rates than non-laying hens, probably due to extra oxygen and calcium requirements for eggshell production, although the calculated blood flow difference was not statistically significant. Histological embedding and sectioning along with vascular contrast imaging reveal variable nutrient foramen morphology and nutrient artery location among femora with more than one nutrient foramen., (© 2021 Anatomical Society.)

Objective In this study, we aimed to analyze the anatomy of adult humerii nutrient foramina in the Pakistani population, including the number, size, and relative position of the nutrient foramen in relation to the outer surface and zones, as well as length from the center of the humerus. Materials and methods Dry humerii of unknown age and gender were included and analyzed through non-probability convenience sampling. Those that were broken or had any pathology were excluded. The length of the humerus (cm), the number, size, and position of the nutrient foramen in relation to humerus surfaces and zones, as well as the distance from the humerus midpoint were studied. When many foramina were identified, the largest was designated as prominent foramen, and its dimensions (mm) were calculated. The data were collected and analyzed, i.e., mean, range, percentage, and standard deviation. Results A total of 50 adult dry humerii of unknown age and gender were studied. The humerii had a mean length of about 27.96 ±2.18 cm. The nutrient foramen had a mean size of about 0.828 ±0.26 mm. The mean distance from the humerus center to the major nutrient foramen was nearly 2.31 ±1.25 cm. The nutrient foramen was discovered in the bone in the middle one-third of humerii (84%) and 12% in the lower one-third, while it was only detected in 4% in the top one-third. The nutrient foramen was located in the anteromedial surface 80% of the time, the posterior surface 12% of the time, and the anterolateral surface 8% of the time. Conclusion Based on our findings, the nutrient foramina of adult humerii in the Pakistani population studied were discovered in the anteromedial and posterior surfaces on the anterolateral. Additionally, the nutrient foramen was identified in the middle and lower thirds of the humerii. The majority of the humerii had only one nutrient foramen, while a few humerii had several nutrient foramina. We believe physicians will find our results useful in treating humeral injuries and illnesses., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Haris et al.)

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.

The localization of nutrient foramina and direction of nutrient canals have been studied. However, information about the origin and extraosseous course of nutrient arteries is lacking in some types of long tubular and irregular bones. Thus, we aimed to reexamine the origin and course of the femoral nutrient artery (FNA) through cadaveric dissection to clarify its anatomic characteristics. Sixty thighs were collected from 57 cadavers. To fix the cadavers and visualize the small arterial branches, 10% formalin was injected from the femoral artery, followed by an injection of acrylic ink. The arterial tree in the posterior part of the thigh was recorded by line drawings. The femur received single or double FNAs via the femoral nutrient foramina, which were on and along the linea aspera. In cases with single FNA (41 of the 60 thighs), it typically arose from the four parts of the profunda femoris system: profunda femoris artery between the origins of the third and fourth perforating arteries; second perforating artery; third perforating artery; and terminal branch. In cases with double FNAs (remaining 19 thighs), the superior FNA typically arose from the second perforating artery, and the inferior FNA arose from the terminal branch of the profunda femoris artery and popliteal system. FNAs are described as branches of the perforating arteries in Terminologia Anatomica and anatomy textbooks. However, we found that FNAs also frequently arose from the profunda femoris artery and popliteal system, in addition to the perforating arteries. Clin. Anat. 33:479-487, 2020. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

Nutrient arteries provide the endosteal blood supply to maintain bone remodelling and energy metabolism. Here, we investigated the distribution and function of perivascular nerves in regulating the contractility of the tibial nutrient artery. Changes in artery diameter were measured using a video tracking system, while the perivascular innervation was investigated using fluorescence immunohistochemistry. Nerve-evoked phasic constrictions of nutrient arteries were suppressed by phentolamine (1 μM), an α-adrenoceptor antagonist, guanethidine (10 μM), a blocker of sympathetic transmission, or fluoxetine (10 μM), a serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitor. In arteries pretreated with guanethidine, residual nerve-evoked constrictions were abolished by a high concentration of propranolol (10 μM) that is known to inhibit 5-HT receptors, or ketanserin (100 nM), a 5-HT 2 receptor antagonist, but not SB207216 (1 μM), an antagonist of 5-HT 3 and 5-HT 4 receptors. Bath-applied 5-HT (100 nM) induced arterial constriction that was suppressed by propranolol (10 μM) or ketanserin (100 nM). Nerve-evoked arterial constrictions were enhanced by spantide (1 μM), a substance P (SP) receptor antagonist, or L-nitro arginine (L-NA; 100 μM), an inhibitor of nitric oxide synthase (NOS). Immunohistochemistry revealed 5-HT-positive nerves running along the arteries that are distinct from perivascular sympathetic or substance P-positive primary afferent nerves. For the first time, functional serotonergic nerves are identified in the tibial nutrient artery of the guinea pig. Thus, it appears that tibial nutrient arterial calibre is regulated by the balance between sympathetic and serotonergic vasoconstrictor nerves and vasodilator afferent nerves that release substance P-stimulating endothelial nitric oxide (NO) release.

The nutrient arteries, located in the long bone diaphysis, are the major blood supply to long bones, especially during the early phases of growth and ossification. Their intersection with the central axis of the medullary area corresponds to the ossification center, and their opening on the outer bone surface to the nutrient foramen. Nutrient arteries/foramen have essentially been analyzed in humans, and only to a much lesser extent in a few mammals. Some studies have taken measurements of the nutrient foramen; others have investigated the shape and orientation of the nutrient canals, although only partially. No studies have analyzed the nutrient canal in three dimensions inside the bone and the relationships between nutrient foramen, nutrient canal, growth, and physiology require further investigation. The current study proposes to investigate in three dimensions the shape of the nutrient canal in stylopod bones of various mammals. Qualitative and quantitative parameters are defined to discuss the diversity in, for example, morphology, orientation, and diameter encountered, resorting to two different datasets to maximize differences within mammals and then analyze variation within morphologically and phylogenetically closer taxa. This study highlights a strong intraspecific variation for various parameters, with limited biological signal, but also shows trends. It notably provides evidence that canals are generally more numerous and relatively thinner in less elongated bones. Moreover, it shows that the growth center is located distally in the humerus and proximally in the femur, and that the canals are essentially oriented towards the faster growing end, so that the nutrient foramen does not indicate the location of the growth center. This result seems general in mammals but cannot be generalized outside of Mammalia. Further analyses of the features of nutrient arteries in reptiles are required to make comparisons with the trends observed in mammals., (© 2019 Anatomical Society.)

Background: The aims of this study were to identify the artery feeding the fifth metatarsal and determine how bunionette osteotomy could injure this vessel., Methods: The nutrient artery entering the fifth metatarsal was investigated in 10 adult cadaveric lower limbs by barium injection and enhanced computed tomography., Results: The nutrient artery entered the medial aspect of the fifth metatarsal around the junction of the middle and proximal thirds obliquely from a distal direction (mean angle 36°) in the coronal plane in all cases; in the axial plane, the point of entry and direction of the artery was medial-plantar (mean angle 49°)., Conclusions: This report revealed direction and location of the nutrient artery entering the fifth metatarsal., (Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: Osteotomy for hallux valgus interrupts intraosseous blood supply to the first metatarsal, presumably causing non-union, delayed union, or osteonecrosis of the head of the first metatarsal. We investigated the first metatarsal nutrient artery, arising from the first dorsal metatarsal artery, and identified aspects of surgical technique contributing to nutrient artery injury., Methods: Enhanced computed tomography scans of 8 feet of 8 fresh cadavers were assessed. Barium was injected through the external iliac artery; location and direction of the first metatarsal nutrient artery was recorded., Results: Mostly, the nutrient artery entered the first metatarsal at the distal third or junction of the middle and distal thirds obliquely from a proximal direction coronally; entry point and direction varied axially. Saw blade overpenetration alone or with extensive capsular stripping might damage the artery., Conclusions: Location and direction of the first metatarsal nutrient artery was established., (Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: Osteotomies of the lesser (second to fourth) metatarsals are often used to correct forefoot deformities. However, certain areas of the lesser metatarsals where arteries may be prone to damage during surgery, and the resulting nonunion and delayed union could cause serious problems. This study sought to identify the nutrient arteries of the lesser metatarsals and to determine how osteotomy could injure these vessels., Methods: Enhanced computed tomography scans of 21 ft (male, n  = 10; female, n  = 11; mean age 78.6 years at the time of death) were assessed. Twenty-one lower limbs in 21 cadaveric specimens were injected with barium via the external iliac artery, and the points at which the nutrient arteries entered the lesser metatarsals were identified on axial and coronal images., Results: Each nutrient artery entered the lateral or medial plantar aspect of the lesser metatarsal in the middle third (just proximal to the middle point of the metatarsal) or proximal third obliquely from a distal direction. The mean ± standard deviation (SD) distances from the dorsal plane of the second, third, and fourth metatarsals to the point of entry of the nutrient artery in the axial plane were 8.2 ± 1.5, 7.6 ± 1.2, and 7.6 ± 1.5 mm, respectively. The mean ± SD distances from the distal epiphysis to the point of entry of the nutrient artery into the second, third, and fourth metatarsals in the coronal plane were 3.3 ± 1.1, 3.1 ± 1.0, and 2.8 ± 1.2 mm, respectively. The mean ± SD distances from the distal epiphysis to the point of entry of the nutrient artery into the second, third, and fourth metatarsals in the coronal plane were 46.0 ± 5.2, 40.9 ± 2.6, and 39.1 ± 3.7 mm, respectively. The mean ± SD distances from the proximal epiphysis to the entry point of the nutrient artery into the second, third, and fourth metatarsals in the coronal plane were 23.8 ± 4.7, 25.8 ± 4.3, and 25.0 ± 3.2 mm, respectively., Conclusions: Distal metatarsal osteotomies might be safer than shaft or proximal osteotomy to avoid disruption of the nutrient artery, leading to delayed consolidation of the osteotomy and nonunion., Competing Interests: This study was approved by the research board of Tokushima University Hospital (reference no. 2258). Not applicable. The authors declare that they have no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: The localization of nutrient foramens has been extensively studied in humans and other vertebrate animals. However, accurate information on the origin and extraosseous course of the nutrient arteries in some types of long tubular bones is lacking. Terminologia Anatomica, the international standard on human anatomic terminology, lists the radial nutrient artery (RNA) and the ulnar nutrient artery (UNA) as branches of the radial and ulnar arteries, respectively. Anatomy textbooks published in both German- and English-speaking countries regard both the RNA and UNA as branches of the anterior interosseous artery., Methods: To clarify the anatomic characteristics of the RNA and UNA in humans, we reexamined the origin and course of these arteries by cadaveric dissection., Results: Almost all RNAs and UNAs branched from the ulnar artery or its tributaries. In typical cases, the RNA branched from the anterior interosseous artery and the UNA branched from the proximal part of the ulnar artery or the anterior interosseous artery. These findings are reasonable from the perspective of regional anatomy, since the ulnar artery passes more deeply than the radial artery in the proximal forearm and thus the proximal part of the ulnar artery and its major branches are situated more closely to the radial and ulnar nutrient foramens., Conclusions: Based on our findings, it is necessary to correct the position of the RNA and UNA in the arterial hierarchy of T. Anatomica for accurate morphological description., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Anatomic characterization of the humeral nutrient artery varies among the several textbooks on human anatomy. To clarify the anatomic characteristics of the humeral nutrient artery, we reexamined its origin and course by cadaveric dissection. In typical cases, one prominent nutrient foramen was situated on the anteromedial surface of the humeral shaft, and the nutrient canal distally penetrated the cortical bone layer. The humeral nutrient artery originated from the brachial artery below the level of the nutrient foramen as a short ascending branch. On reaching near the nutrient foramen, the humeral nutrient artery formed a hairpin loop on the periosteum to enter into the nutrient foramen. In some cases, an accessory nutrient foramen was also found near the groove for the radial nerve on the posterior surface of the humerus. This accessory nutrient foramen received an accessory humeral nutrient artery that originated from the radial collateral artery. The present findings corresponded well with the descriptions in the anatomy textbooks published in English-speaking countries. However, textbooks published in German-speaking countries describe only one type of humeral nutrient artery, the branch of the profunda brachii artery. Terminologia Anatomica, the international standard in human anatomic terminology, most likely adopted the description in the German anatomy textbooks, and thus, it is necessary to correct the position of the humeral nutrient artery in the hierarchy of Terminologia Anatomica for accurate morphological description. Clin. Anat. 30:978-987, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Background: It is not uncommon to see the non union of the fractures in the long bones. Among the various reasons for the nonunion of the fractured bones, the nutrient artery plays an important role., Objectives: This study was aimed at analyzing the nutrient foramina in dry adult humerii ,with regards to the number, size and the location of the nutrient foramen with respect to the surfaces and the zones and its distance from the mid point of the humerus., Materials: This was an analytical study. All the humerii from various medical colleges of the Vinayaka Missions University in Salem were included in the study. Those which were damaged and those which had pathological abnormalities were excluded. The following parameters were noted; namely, the length of the humerus, the number and the size of the nutrient foramen and the location of the nutrient foramen with respect to the surfaces and the zones of the humerus and its distance from the mid-point of the humerus were analyzed. The length of the humerus and the mid point of the humerus were measured by using the osteometric board, whereas the size of the nutrient foramen was measured by using various size of hypodermic needles. When more than one foramen was found, the larger one was taken as the dominant foramen and its size was measured. All the data were noted and the statistical analysis was done by calculating the mean, the range and the standard deviation., Results: Totally, 258 adult dry humerii were studied. The mean length of the humerii was 27.96 cm, with a SD of 2.18. The mean size of the nutrient foramen was 0.828 mm, with a SD of 0.26. The mean distance of th dominant nutrient foramen from the mid point of the humerus was 2.31 cm, with a SD of 1.25 cm. In majority of the humerii (86.43%), the nutrient foramen was located in the middle 1/3(rd) of the bone and in 13.57% of the bones, it was located in the lower 1/3(rd) of the bone. The location of the nutrient foramen in the anteromedial surface was 89.92%, that in the posterior surface was 8.53% and that in the anterolateral surface was 1.55%.