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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.

Background: Nutrient artery canals of the femur are often visible on plain radiographs as radiolucent lines which may mimic fracture lines. The purpose of this study was to distinguish nutrient artery canals from fracture lines on plain radiographs. Materials and Methods: Ninety-three patients (102 hips) with an average age of 65.6 years were included in the study. We retrospectively analyzed nutrient artery canals of the femur on pre and postoperative anteroposterior (AP) and cross-table lateral (CTL) hip radiographs in patients with cementless total hip arthroplasty. The shape, number, location, direction of obliquity, length of nutrient artery canal, and the distance between the tip of the greater trochanter and the proximal end of the nutrient artery canal were measured. Results: Nutrient artery canals were determined in 54 hips (53.0%) on preoperative radiographs. The numbers of nutrient artery canals were entirely found to be one for each hip. The nutrient artery canals of the femur were the most frequently seen in the cortex on CTL radiographs with 32 hips (31.4%), whereas nutrient artery canals were not seen at all in the cortex on AP radiographs. All nutrient artery canals in the cortex on CTL radiographs coursed upward obliquely. Comparing to fracture lines, nutrient artery canals show less radiolucency, smaller diameter, and blunted ends in both the cortex and medullary cavity, show sclerotic walls in the cortex and have the less straight course in the medullary cavity. Conclusions: Based on the results of this study, there are clearly distinguishable differences between nutrient artery canals of the femur and fracture lines on plain radiographs.

Background Metanephric adenoma (MA) is a benign renal tumor that is difficult to distinguish from a malignant tumor via traditional radiography. The diagnosis of MA is often dependent on postsurgical histopathological examination. In the present report, the imaging features of MA on computer tomography (CT) and magnetic resonance imaging (MRI) were retrospectively evaluated. Methods Eight MA patients, 17–67 years of age, were pathologically confirmed and recruited between April 2009 and November 2014. Four of the eight patients were female. All patients underwent CT scanning, and one patient underwent MRI scanning. Three patients underwent CTA of the renal arteries. All patients underwent resection surgery (radical nephrectomy in five and nephron-sparing surgery in three patients). Results The average tumor size was 44.0 ± 23.6 mm. The lesions in 87.5 % cases were located both in the renal cortex and medulla and exhibited exophytic growth. Plain CT showed that MA tumors were solid, and the average CT value was 37.9 ± 6.7 HU. Dynamic contrast-enhanced CT revealed that enhanced degrees of MA tumors in the renal cortex, renal parenchymal, and pelvic phase were all lower than that of normal renal parenchyma. A slight enhancement in the renal cortex phase and an even higher enhancement in the renal parenchymal phase were observed in seven of the cases. Progressive enhancement in the pelvic phase was found in five cases and a slight decreased enhancement in the pelvic phase in two cases. MRI revealed that MA tumor was isointense on T1WI and isointense on T2WI with some slightly hyperintense areas in the center. CTA of the renal arteries revealed the nutrient artery in one patient and no nutrient artery in two. Immunohistochemical experiments demonstrated that most tumor cells were positive for vimentin, CK, and EMA. Conclusions MA is a rare benign renal neoplasm. Detailed knowledge of the CT and MRI characteristics of MA plays an important role in MA diagnosis and treatment.

Background Humeral shaft fractures are generally managed with the conventional posterior open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This study was aimed at comparing the outcomes of these surgical techniques in terms of the vascular integrity of the mid-distal humeral shaft. Methods Twelve upper limbs were harvested from 6 fresh cadavers. ORIF or MIPO was randomly performed on either side of each pair of limbs. The axillary artery was perfused with a latex-lead tetraoxide red solution to visualize the vascular structures. The vascular integrity of the humerus was examined by plain radiography and dissection. The periosteal filling achieved with each technique was scored and the scores compared. Results In each limb, one main nutrient artery entering the mid-distal humeral shaft anteromedially (83.3 %) or medially (16.7 %) was first identified. No case of injury to the main nutrient artery was noted for either surgical technique. Injuries to the accessory nutrient arteries entering the mid-distal humeral shaft from the posterior aspect were absent in the MIPO cases, but occurred in 52.9 % of the ORIF cases. In addition, MIPO was also superior to the open plate technique showed superior periosteal filling than. Conclusions Our results showed that the MIPO technique is superior to the ORIF in terms of preserving the vascular integrity of the mid-distal humeral shaft.

The aim of this study was to evaluate the number, course, width and location of nutrient artery canals of the femur by using multidetector computed tomography (MDCT). Sixty-six adult (35 right and 31 left) dry femurs were included in this study and scanned by MDCT. Nutrient artery canals were evaluated on the multi-planar reformatted and volume rendered images which were reproduced on the basis of axial images. The median value of nutrient artery canals was two (minimum 1 and maximum 6). We determined that there was a negative correlation between the number of nutrient canals and the canal diameters. The outer ostia of the nutrient artery canals were most frequently located at the middle third segment of femoral diaphysis (65%). While the vast majority of the canals were showing upward courses (95%), only a few canals were having transverse (3%) or downward (2%) courses. Most encountered location of outer ostia of the canals according to linea aspera was the medial lip of the linea aspera (44%). Various variations were demonstrated in the number, course, and location of nutrient artery canals using MDCT. In conclusion, the knowledge of the topographic features of the nutrient artery canals may be useful in various clinical implications such as bone grafting or radiologic evaluation for the fracture lines.

Down syndrome (DS) may be associated with various organ system disorders. Feeding problems are frequent in children with DS and may be caused by associated defects, including congenital heart defects, gastrointestinal defects, or endocrine disorders. In the absence of these associated conditions, feeding problems are often attributed to general hypotonia. However, an aberrant right subclavian artery (ARSA), a rare vascular anomaly and an unusual cause of problems with the passage of solid food through the esophagus, has recently been suggested to occur more frequently in patients with DS. This knowledge is of importance when evaluating feeding difficulties in patients with DS. Additional investigation for identifying an ARSA may be indicated in selected patients. Diagnostic techniques, such as transthoracic echocardiography, barium contrast esophagram, angiography, or computed tomography-angiography (CT) can be used in a diagnostic flow chart. The presence of ARSA is not synonymous to the cause of feeding problems in patients with DS and corrective surgery of this vascular anomaly should be restricted to selected cases.

A prospective radiologic and scintigraphic study was made of 15 joints in 12 patients who underwent transtrochanteric rotational osteotomy of the femoral head after identifying by preoperative superselective angiography which arteries should be preserved during surgery. The preoperative superselective angiography revealed that the blood supply to the femoral head was provided by the medial femoral circumflex artery in 12 joints and a branch of the internal iliac artery in 3 joints. These nutrient arteries were preserved during surgery. At the follow-up examination made after at least 2 years, there were no cases of collapse of the new femoral head weight-bearing site, and also there were no cases with a large cold area in the femoral head on the scintigram obtained 2 months postoperatively. For this operative procedure, the nutrient arteries of the femoral head should be confirmed by preoperative superselective angiography, and it is essential that these arteries be preserved during surgery.

Purpose To find and describe potential MRI criteria of nutrient vessel canals of carpal bones. Methods and material 16 wrists of 13 patients with pain and radiographic depiction of cystic changes within the lunate were examined. The MRI protocol included coronal and sagittal T1- and T2-weighted SE sequences (4 mm slices, 120 FOV, 256 x 256 matrix) as well as coronal STIR images. Final diagnosis was confirmed by surgery (n = 5) and follow up. 10 cadaveric ossa lunata were studied to describe size, number, location and shape of nutrient vessel canals. Results Ganglion cysts (n = 6) showed characteristic signs. In ulnar impaction syndrome (n = 1) small cystic lesions in the lunate were surrounded by a sclerotic rim and located near the proximal ulnar surface. In Kienbock's disease (n = 3) cystic components were irregular and surrounded by bone marrow edema. Nutrient vessel canals (n = 7) imaged as 1 to 3 small cystic lesions within the palmar or dorsal subchondral region. Conclusion MRI can aid in differential diagnosis of cystic carpal lesions. Nutrient vessel canals may not be mistaken for pathologic cystic lesions. Carpal ganglion cysts show distinct diagnostic pattern.

The present study was designed to determine whether there is a physiological explanation for the predisposition of patients with certain angiographic characteristics to haemorrhage from cerebral arteriovenous malformations (AVMs).Intra-operative measurement of feeding artery pressure (FAP) and intravascular pressures in the draining venous system [draining vein pressure (DVP) and cranial sinus pressure (SP)] were performed for 30 AVM cases using direct puncture of the vessels. The correlation between pressures and previously described angiographic characteristics predisposing to haemorrhage were evaluated.Small nidus size and only one draining vein increased the risk of haemorrhage. FAP and DVP are both inversely related to the number of draining veins and the size of the AVMs. DVP was significantly higher in AVMs with haemorrhage (23.1+/-8.7 mmHg) than in those without (13.5+/-4.4), as was FAP (58.6+/-12.8 as opposed to 38.7+/-4. 7) (p0.05). Moreover, the difference between systemic blood pressure and the FAP with haemorrhagic AVMs (17.0+/-9.5 mmHg) was significantly lower than that in nonhaemorrhagic cases (33.7+/-5.5) (p0.05). The pressure difference between the feeding artery and draining vein was not significant between the haemorrhagic and nonhaemorrhagic groups. There was no significant difference of SP between haemorrhagic and nonhaemorrhagic patients.The present study suggests that a high DVP probably induced by high resistance in the venous drainage system, as well as a high FAP, may contribute to the development of haemorrhage from AVMs, and physiologically supports previous reports that small AVMs and AVMs with only one draining vein are susceptible to haemorrhage.

Dear Editor, We read with deep interest the article by Tong et al. [1]. We appreciate the work of the authors on the paper. However, Figs. 2 and 3 made us interested in the position of external fixation of the pilon fracture given by the authors. The authors stated Figs. 2 and 3 indicated that the three 4.5-mm pins were usually applied on the anterior surface of the proximal tibia. We found something interesting when following the instructions at our clinic. In one patient, the proximal pins of the external fixation nearly penetrated the tibial nutrient artery (Fig. 1). Fig. 1 The CT scan shows that the tibial nutrient artery (white arrow) was nearly damaged by the proximal pin of external fixation According to previous studies, most people have only one tibial nutrient artery which supplies the inner two thirds of the cortex and is the chief blood supply of cortical bone [2]. It arises from the anterior aspect of the posterior tibial artery, very close to the origin of the latter from the popliteal artery. The nutrient artery then penetrates the tibialis posterior muscle close to its origin from bone. It enters a groove on the posterior surface of the tibia, leading distally to the very oblique nutrient canal which in man may traverse the cortex for a distance of 5.5 cm [3, 4]. The proximal pins of external fixation have a higher probability of penetrating the tibial nutrient artery especially from the anterior surface of one third to two thirds of the tibia. The blood supply of the tibia will have been damaged in the fractures. If the tibial nutrient artery were to be damaged as well, the incidence of nonunion or delayed union of tibia fractures will increase significantly. To summarise, we advocate that the proximal pins of external fixation should be fixed from a lateral and not an anterior approach. In this way, the tibial nutrient artery can be protected and the incidence of nonunion or delayed union of fractures can be decreased. This interesting finding cannot lessen this review’s overall value and we thoroughly enjoyed reading and appreciating the paper.

This is a case report of ameloblastoma of left mandible. It was treated with left extended hemimandibulectomy with free fibular vascular graft.

Several laboratories, including our own, have investigated the physiology of bone blood flow by perfusion of the tibia via the nutrient artery. Any damage caused to the nerve supply by cannulation of the artery might affect the results. The possible effect of such damage was investigated by measuring blood flow to the dog tibia using a microsphere technique, before and after sympathectomy. No effect was found and the tibial nutrient artery is therefore a suitable vessel for perfusion when estimating nutrient exchange in bone.