International Journal of Morphology
On-line version ISSN 0717-9502
Int. J. Morphol. vol.25 no.2 Temuco June 2007
Int J. MorphoL,25(2):305-308, 2007.
Diaphyseal Nutrient Foramina in the Femur, Tibia and Fibula Bones
Forámenes Nutricios Diafísarios de los Huesos Fémur, Tibia y Fíbula
Erika Collipal; Ramiro Vargas; Ximena Parra; Héctor Silva & Mariano del Sol
Facultad de Medicina, Universidad de La frontera, Temuco, Chile.
SUMMARY: The nutrient foramina of the femur and fibula are located in the middle third of the diaphysis of these bones, on the other hand in the tibia it's in the proximal third of its diaphysis. With the objective of complementing the information delivered by other authors, we investigated the location, the number of diaphysis foramines, the distance or position of the foramines in relation to the length of the bone and the proximal epiphysis and the diameter of the bone at the height of the foramen. For that purpose, we used 140 dry bones (50 femora, 50 tibiae and 40 fibulae) of adult subjects of both sexes from the Anatomy Museum Faculty of Medicine, Universidad de La Frontera, Temuco, Chile.
The nutrient foramen of the femur was located in the linea áspera in the 72,5% (36,25% in the interstice, 8,75 in the lateral lip of the linea áspera and 27,5 in the medial lip of the linea áspera), and in the 21,25% in the medial surface and in the 6,25% in the lateral surface of the diaphysis of the bone. The nutrient foramen of the tibia was found under the soleal line in a 94,33% at an average distance of 117.8mm from the intercondylar eminence to the nutrient foramen (in the superior third of the bone), in the soleal line of the bone in 3,77% and in the lateral border in 1,88%. In the fibula the nutrient foramen was found in the 68% in the posterior surface; 14% in the medial surface; 12% in the interosseous border; 4% in the lateral surface and 2% in the posterior border. This data could be useful as reference for surgical procedures of the lower limb.
KEY WORDS: Nutrient foramen; Bones; Lower limb.
RESUMEN: Los forámenes nutricios del fémur y de la fíbula se localizan en el tercio medio de la diáfisis de estos huesos, mientras que, en la tibia se encuentra en el tercio proximal de su diáfisis. Con el objetivo de complementar la información dada por otros autores, estudiamos, la ubicación, número de forámenes, distancia o posición de los forámenes en relación a la longitud del hueso y a la epífisis proximal y el diámetro del hueso a la altura del foramen. Para ello, utilizamos 140 huesos secos (50 fémur, 50 tibias y 40 fíbulas), de individuos adultos, de ambos sexos, procedentes del Museo de Anatomía, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.
El foramen nutricio del fémur se localizaba en la línea áspera en el 72,5% (36,25% en el intersticio, 8,75 en el labio lateral de la línea áspera y 27,5 en el labio labio medial de la línea áspera), en el 21,25% en la cara medial y en el 6,25% en la cara lateral de la diáfisis del hueso. El foramen nutricio de la tibia fue encontrado bajo la línea del músculo soleo en un 94,33%, a una distancia promedio de 117,8 mm desde la eminencia intercondílea al foramen nutricio (en el tercio superior del hueso), en la línea del músculo soleo en 3,77% y en el margen lateral en 1,88%. En la fíbula el foramen nutricio fue encontrado en el 68% en la cara posterior; 14% en la cara medial; 12% en el margen interóseo; 4% en la cara lateral y 2% en el margen posterior. Estos datos sirven como referencia para procedimientos quirúrgicos del miembro inferior.
PALABRAS CLAVE: Foramen nutricio; Huesos; Miembro inferior.
The vascularization of the long bones generally is given by one or two diaphyseal nutrient arteries and numerous metaphysiary and epyphisiary arteries. The diaphyseal nutrient arteries obliquely penetrate in the diaphyseal of the long bones, their entrance point and angulation being relatively constant, dividing in ascending and descending branches, once they reach the medular cavity. As a characteristic the diaphyseal nutrient vessels move away from the growth extremity dominant in the bone. In the irrigation of the long bones, the epyphisiary and metaphisiary nutrient arteries also participate, which are very important forming a series free of intrabone anastomosis.
The principal nutrient foramina of the femur are located toward the middle of the linea áspera (Schaeffer, 1953; Orts-Llorca, 1963; Testut & Latarjet, 1971) with a possible variation in number and position, located in proximity to the linea áspera, generally one is located near the proximal extremity of the linea áspera and a second, that is not always present, in proximity to its distal extreme (Williams & Warwick, 1995), can be found in a point of the medial surface of the bone always near the linea áspera (Rouviére & Delmas, 1999).
The nutrient artery of the femur in general proceeds of the second perforating artery and when two nutrient arteries exist, they tend to detach from the first and third perforating arteries (Goss, 1976).
Authors such as Testut & Latarjet; Orts-Llorca; Williams & Warwick; Goss; Chatain-Bustamante (1989) have described that in the posterior surface of the diaphyseal of the tibia, a bit under the soleal line, is the nutrient foramina. For Williams & Warwick the area under the soleal line is divided by a slight vertical line that initiates under the soleal line and then disappears. An evident vascular circle marks the bone next to the superior extremity of the vertical line and descends for an ample nutrient foramina, which can be situated laterally or medially in the vertical line.
In the fibula, the nutrient foramina is situated in the medial crest of the bone in its surroundings, in proximity to the middle part of the diaphyseal, according to the observations of Williams & Warwick. According to some the diaphyseal nutrient foramina of the fibula would be located in the middle third of the posterior surface with an obliquely downward direction.
The objective of the investigation was to contribute details of the irrigation of the femur, tibia and fibula bones, specifically determining the location and biometric characteristics with respect to the diaphyseal nutrient foramina.
MATERIAL AND METHOD
We used 140 dry bones (50 femur, 50 tibias and 40 fibulas) of adult subjects of both sexes, from the Anatomy Museum of the Faculty of Medicine of the Universidad de La Frontera, Chile.
The location and the number of diaphyseal nutrient foramina that each of the bones presented, were identified. The measurements were realized with a Broca osteometer and a digital calipers. The data was statistically analized. The following measures were registered: Maximum length of the bones, distance between the nutrient foramina and the apex of the greater trochanter of the femur, distance betwen the nutrient foramina and the highest point of the intercondylar eminence of the tibia, distance between the nutrient foramina and the apex of the head of the fibula, anteroposterior and lateromedial diameters of the bones at the height of the nutrient foramina.
The average of the length of the right femur was of 435.2mm (range 393-523 mm) and the left of 437 mm (range 369-524 mm). The nutrient foramina of the femur was located in the linea áspera in the 72,5% (36.25% in the interstice 8,75 in the lateral lip and 27,5 in the medial lip of the linea áspera, in the 21,25% in the medial face and in the 6,25% in the lateral face of the diaphysis of the bone.
In the right tibia the average length was of 3 5 8. 8mm (range 319-436mm), in the left tibia it was 354,9mm (range 310-446mm). The nutrient foramina of the tibia was found under the soleal line in a 94.33%, at an average distance of 117,8 mm from the apex of the intercondylar tuberculum to the nutrient foramina (in the superior third of the bone), in the soleal line in 3,77% and in the lateral border in 1,88%.
The average length of the right fibula was 351,4mm (range 314-422mm). The left was of 341mm (range 298-374mm). In the fibula, the nutrient foramina was found in the 68% of the posterior surface; 14% in the medial surface; 12% in the medial border; 4% in the lateral surface and 2% in the lateral border.
The results found in the variables investigated, in relation to the number of foramina that the femur, tibia and fibula bones presented, maximum length of the bone, distance of the proximal epiphysis to the foramina, lateromedial diameters and the height of the foramina in each bone are presented in Tables I, II, III and IV.
The diaphysis of the large bones is irrigated by one or various nutrient arteries that pierce through the compact bone and divide in the medular cavity in ascending and descending branches, while accompanied by, in proximity to the bone extremities, by the terminal branches of numerous metaphysiary and epiphysiary arteries.
Kirschner etal. (1998), investigated the variations and the division of the deep circumflex trunk and determined the location and number of nutrient foramina in 200 femur and 200 tibias. They found two foramina in 57%, one foramen in 35% and three foramina in 8% of the cases. A foramen was found in 60% by Forriol et al. (1987); 50% by Mysorekar (1967) and 46% by Sendemir & Cimen (1991), in comparison to 44% of our investigation.
We concur with Mysorekar; Longia et al. (1980); Sendemir & Cimen and Gumusburun et al. (1994) who pointed out that in the femur the nutrient foramina is restricted to a linea áspera or adjacent zones, locating itself in the medium third of the bone. The presence of the nutrient foramina in the medial or lateral surfaces is not frequent, the finding in our investigation was that of only 27%; however, Sendemir & Cimen pointed out that in 7.1% this foramina was found in the anterior surface of the femur.
In the transplant of the femoral diaphysis the deep femoral artery can be used, if the lateral circumflex femoral artery is protected. In the case of shorter grafts, it is necessary to consider the number and the location of the nutrient foramina. In grafts of a major longitude the distal branches of the femoral artery must be respected, as the intrabone irrigation distally reaches up to an approximate level of 8 cm above the femoral condyle (Kirschner et al.).
In the tibia we observed that in 94% a diaphyseal foramen existed and only two foramina in 6% of the cases very similar to that reported by Longia et al. (95% a foramen and 5% two foramina); Kirschner et al. (93.5% a forame and 6.5% two foramina); Gumusburumeia/. (84.9 one foramina). For Mysorekar in 99% only one nutrient forame exists in the tibial diaphysis. Gomez et al. (1988), point out that one strong interdependency exists between the situation of the nutrient foramina and total length of the bone.
In the fibula we found that 75% of the bones presented a forame and 25% two foramina, its most frequent location being in the middle third of the posterior surface of the bone. Similar data has been contributed by Mysorekar (92.85%); and higher by Gumusburun etal. (84.9%; Longia etal, (85.19%); Sendemir (73.9%) and Forriol (100%).
The knowledge of the position of the nutrient foramina of the fibula is important in order to proceed with the free implant of the vascularized bone. The nutrient foramina is located in the middle third of the fibula, in the majority of the cases, thus is the segment that must be used for the transplant, if one desires that the implant include endosteal vascularization and peripheral vascularization. (Moore, 1997).
Finally it is necessary to point out that the average of the lateromedial diameter, at the level of the nutrient forame, in two right bones was greater than in the left, in accordance with the investigations realized by Collipal etal. (2003) in other bones.
Chatain-Bustamante, I. Anatomía microscópica, funcional y clínica. Addison-Wesley, Iberoamericana, 1989. [ Links ]
Collipal, L. E.; Olave, E. & Silva, M. H. Características biométricas de los forámenes nutricios en los huesos húmero, ulna y radio. Int. J. Morphol, 21(3):227-230,2003. [ Links ]
Forriol, E.; Gómez, L.; Gianonatti M. & Fernández, R. A study of the nutrient foramina in human long bones. Surg. Radiol. Anal, 9:251-5, 1987. [ Links ]
Gómez Pellico, L.; Forriol, C. F. & Gianonatti A. M. Comportamiento estadístico de la morfología externa de algunos huesos largos del esqueleto. Anales de Anatomía Normal, 6:188-193, 1988. [ Links ]
Goss, Ch. M. Gray Anatomía. Barcelona, Salvat Editores. 1976. [ Links ]
Gümüsburun, E.; Yücel, E; Ozkan, Y & Akgün, Z. A study of the nutrient foramina of lower limb long bones. Surg. Radiol. Anal, 16: 409-412, 1994. [ Links ]
Kirschner, M. H.; Menck, J.; Hennerbichler, A.; Gaber, O. & Hofmann, G. O. Importance of arterial blood to the femur and tibia for transplantation of vascularized femoral diaphyses and knee joints. World. J. Surg., 22:845-52,1998. [ Links ]
Longia, G. S.; Ajmani, M. L.; Saxena, S. K & Thomas, R. J. Study of diaphyseal nutrient foramina in human long bones. Acta anal, 107:399-406, 1980. [ Links ]
Mysorekar, V. R. Diaphysial nutrient foramina in human long bones. J. Anal, 101:813-22, 1967. [ Links ]
Moore, K. L. Anatomía con orientación clínica. 3a. Ed. Madrid, Panamericana, 1997. [ Links ]
Orts Llorca, F. Anatomía Humana. 3a. Ed. Barcelona, Científico-Medica, 1963. V. 1. [ Links ]
Rouviére, H. & Delmas, A. Anatomía Humana. 10a ed. Barcelona, Masso, 1999. V. 1. [ Links ]
Schaffer, P. J. Morris Human Anatomy. IIa. Ed. New Jork, Mc Graw- Hill Book, 1953. [ Links ]
Sendemir, E. & Cimen, A. Nutrient foramina in the shafts of lower limb long bones: situation and number. Surg. Radiol. Anal, 75:105-8, 1991. [ Links ]
Testut, L. & Latarjet, A. Tratado de Anatomía Humana. 9a ed. Barcelona, Salvat, 1971. V. 1. [ Links ]
Williams, P.; Warwick, R.; Dyson, M. & Bannister, L. Gray Anatomía. 37. ed. Rio de Janeiro, Guanabara Koogan, 1995. V. 1. [ Links ]
Prof. Erika Collipal Larre