An Anatomical Study of the Nutrient Foramina of the Human Humeral Diaphysis

Abstract

BackgroundUnderstanding the nutrient foramina is critical to clinical practice. An insult to the nutrient foramina can be caused by trauma and/or surgical dissection and lead to devascularization and bad outcomes. Few studies have looked at the humerus, and no studies have described relative information of humeral nutrient foramen related to anatomical structures that might be located by palpable landmarks. In this study, we analyzed the anatomical features of the nutrient foramina of the diaphyseal humerus and provide a discussion of clinical relevance.Material/MethodsWe dissected 19 cadavers and analyzed the relative positions of the foramina and surrounding muscles, and the number, direction, diameter, and location of the nutrient foramina. Foramina index and a new landmark index were used to calculate the location. We compared the data from both sides and the relationships between transverse and longitudinal locations, diameter and total length, and foramina index and landmark index were also analyzed.ResultsThe humeri had one or two main nutrient foramina located in a small area between the coracobrachialis and brachial muscles and oriented toward the elbow. The mean diameter was 1.11±0.32 mm. The mean index and landmark index were 43.76±4.94% and 42.26±5.35%, respectively. There were no differences between sides in terms of diameter, length, or nutrient foramina index. There were no significant correlations between transverse and longitudinal locations or diameter and total length. The foramina index and landmark index showed strong positive correlation (r=0.994, p<0.0001).ConclusionsOur study provides details about the nutrient foramina that will benefit clinicians who treat injuries and diseases of the humerus. Surgeons should be mindful of soft tissue in the foraminal area during surgical procedures.

Anatomical study of nutrient foramina in humerus

“…We found there were no significant differences between right and left side for total length and for foraminal index. The findings of our study is very close with that of Xue et al (2016), 14 as there were no differences between sides in terms of length or nutrient foraminal index.…”

Three-dimensional topography of scapular nutrient foramina

“…Once fully cleaned, the bone surfaces of all scapulae were scrutinized on the posterior and costal surfaces and borders to assess number and location of the nutrient foramina. Based on methods widely used in literature [4,6,21,22,24,35], only those entry points that admitted the tip of a 24-gauge wire (0.51 mm) were considered nutrient foramina. Hence, nutrient foramen of 0.51 mm and larger were included in this study.…”

Using nutrient foramina to differentiate human from non-human long bone fragments in bioarchaeology and forensic anthropology

“…The only exception is the human humerus, as it is the only human bone that has a unique foramen location. The unique location of the humeral nutrient foramen, between the coracobrachialis and brachialis muscles, is well known in clinical medicine, as the humerus is supplied by a single nutrient artery that is usually affected in case of fractures (Menck et al, 1997;Xue et al, 2016). Thus this location enables the scientist presented with a fragment big enough to be identified as a humerus from a particular side (left or right), to identify it as human if the location of the foramen is anterior, distal and medially located.…”

“…The studies that have focused on nutrient foramina (site, size, and direction) are mainly of clinical and surgical interest, as a thorough knowledge of the characteristics of the nutrient canal and the blood flow that passes through it is vital, for example, in orthopaedic surgery (Gainor and Metzler, 1986), fracture diagnosis and union, tumour resection, and reconstructive surgery of skeletal abnormalities (Xue et al, 2016).…”