MORPHOMETRIC STUDY OF THE NUTRIENT FORAMINA OF UNKNOWN RADIUS AND ULNA AND THEIR CLINICAL IMPORTANCE IN THE REGION OF KADAPA [RAYALASEEMA], ANDHRA PRADESH

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J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 3/Issue 27/Apr. 04, 2016 Page 1222

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. Siddaramulu}2_{, Arun Kumar S. Bilodi}3

1_{Assistant Professor, Department of Anatomy, Dr. NTR UHS, Vijayawada, Andhra Pradesh.}

2_{Associate Professor, Department of Anatomy, Dr. NTR UHS, Vijayawada, Andhra Pradesh.}

3_{Professor, Department of Anatomy, Dr. MGR University, Tamilnadu.}

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

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

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: manukumarreddy@gmail.com

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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 d}_{irection of NF follows the dictum “to the e}_lbow

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:

Left side Right side

Sl. No. Number of NF Location of NF Sl. No. Number of NF Location of NF

1. 1 Anterior surface 1. 1 Anterior surface

6. 1 Interosseous border 6. 1 Anterior surface

Anterior surface

14. 1 Interosseous Border 14. 1 Interosseous Border

15. 1 Anterior surface 15. 1 Posterior surface

19. 1 Anterior surface 19. 1 Interosseous Border

20. 2 Anterior surface

Anterior surface 20. 1 Anterior surface

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27. 1 Anterior surface -

28. 1 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).

Sl. No. Number of Nutrient

Foramina

Location of Nutrient

Foramina Sl. No.

Number of Nutrient Foramina

Location of Nutrient Foramina

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15. 1 Interosseous Border 15. 1 Anterior surface

19. 1 Anterior surface 19. 1 Interosseous Border

23. 1 Anterior surface - -

27. 1 Anterior border

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. Length of the

Bone (cm)

Distance of the Nutrient Foramina (From proximal

end of Bone) [cm]

Sl. No. Length of the

Bone (cm)

Distance of the Nutrient Foramina (From proximal

end of Bone) [cm]

1. 23.5 8 1. 24 8.5

2. 23 8 2. 24 9

3. 24 7.5 3. 24 7.5

4. 23 8 4. 23 8

5. 25 7 5. 25 7.5

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7. 23.5 8 7. 23 7.5

8. 24 7 8. 24 9

9. 24.5 9 9. 24.5 7

10. 24 7 10. 25 7.5

6

11. 24 8.5 11. 25.5 8.5

12. 23 7.5 12. 24 8.5

13. 23 8 13. 23 8

14. 24 9 14. 24 8

15. 23.5 9.5 15. 23.5 8

16. 24 8.5 16. 24 8

17. 24 7 17. 25 7

18. 23 7.5 18. 23 8.5

19. 25 9 19. 24 8

20. 24 8

6.5 20. 25 7

21. 23 8 21. 23 9

22. 24 8.5 22. 24 7

23. 24 9 23. 24.5 8.5

24. 25 8 24. 23.5 7.5

25. 25 7 25. 24 8

26. 24 8 26. 25 9.5

27. 23 7.5 - - ss-

28. 23.5 8 - - -

Mean 23.6 7.8 Mean 24.6 8.2

Foramen

Index 33.05

Foramen

Index 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.

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. 24.5 9 1. 23.5 9

2. 23 9 2. 24 8.5

3. 24 7 3. 23 7

4. 24 9 4. 25 7

5. 25 7 5. 24.5 9

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7. 23.5 9 7. 24 8

8. 24 9 8. 25 7

9. 25 9 9. 24.5 9

10. 24 7.5 10. 24 9

11. 25 9 11. 25.5 8

12. 24 9 12. 25 8

13. 24 9 13. 28.5 10.5

14. 24.5 9 14. 23 9

15. 24.5 9 15. 24 9

16. 24.5 8.5 16. 24 9

17. 24 7 17. 24 7

18. 24 7 18. 23.5 9

19. 25 9 19. 24.5 7

20. 24 9 20. 23 8.5

21. 24 8 21. 24 9

22. 24 9.5 22. 25.5 9

23. 24 9

24. 25 9

25. 25 8

26. 24 8

27. 25 9.5

28. 23.5 9

Mean 24.3 8.6 Mean 24 8.4

Foramen

Index 35.4

Foramen

Index 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.

Radius Ulna

Left side Right

side Total Left side

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

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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:

Radius Ulna

S ingle NF Doub le NF NF o n A nte ri o r s ur fa c e NF o n Inte ro s s e o u s b o rde r NF o n P o s te ri o r s ur fa c e S ingle NF Doub le NF NF o n A nte ri o r s ur fa c e NF o n P o s te ri o r s ur fa c e NF o n A nte ri o r b o rde r

Present study 96.3 3.7 90.7 7.4 1.9 100 - 94 4 2

Ojaswini et al[5] _94.3 _- _5.6 _98.9 _- _-

Ukoha Ukoha et

al[7] 68 91.4 - 8.6 78 100 - -

Bichitrananda et

al[8] 97.29 2.7 100

Pereira et al[9] _99.4 _0.6 _73.2 _98.6 _1.4 _82.2

Satish M Patel et

al[10] 100 87.5 12.5 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]

microvascular bone graft procedures.[15][16]

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]

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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.

REFERENCES:

1. Gray's Anatomy. The anatomical basis of clinical practice. Standring S, Healy JC, Johnson D, Collins P, et al, London: Elsevier Churchill Livingstone 2005;40th

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