Arterial supply of forearm bones and its importance for the operative treatment of fractures

Abstract

The operative exposure of a fracture in an osteosynthesis causes disturbances in the blood supply, which often leads to a prolonged process of healing or even to healing problems, a fracture non-union, which is frequently located at the forearm. In order to damage the supplying vessels as little as possible, the position, direction and penetration of the arteries of radius and ulna are demonstrated and systematised in this study. Near the elbow arteries, coming from large adjoining vessels, penetrate the area of the capsular insertion. The nutrient arteries enter both bones in the second proximal quarter of diaphysis, at the radius from anterior to medial, at the ulna from anterior to anteroradial. Small vessels, which penetrate closely proximal to the articular surface in order to supply the distal forearm bones, come from an anastomosis between the radial, the interosseous and the ulnar arteries. In this study access vessels, choice and position of implants will be discussed.

Topography of Diaphyseal Foramina in Bones of Upper Extremity and Its Surgical Implications

“…The brachial artery or the profunda brachi artery gives rise to the nutrient artery in the humerus [16]. In the radius the nutrient artery arises from the anterior interosseous artery and in the ulna from the ulnar or anterior interosseous artery [17]. Several authors have studied the nutrient foramina of long bones and this knowledge has profound surgical implications in orthopaedic procedures.…”

Morphological And Topographical Anatomy of Nutrient Foramina In Human Upper Limb Long Bones And Their Surgical Importance

“…The anterior interosseous artery, as the mainartery of periosteal and endosteal supply of humanulna and radius, is important in transplantation andreconstruction, especially with a view to reduce the rateof pseudarthrosis [18]. The nutrient arteries of the ulnaand radius enter the bones in the second proximalquarter of diaphysis, at the radius from anterior tomedial, at the ulna from anterior to anterolateral [19]. The available reports on the upper limb bonenutrient foramina include the study on nutrient foraminaof the metacarpals and metatarsals by Singh I [20,21],Patake SM and Mysorekar VR [2], on the radius and ulnaby Shulman SS [22].…”

Nonunion of a Pediatric Distal Radial Metaphyseal Fracture Following Open Reduction and Internal Fixation

“…An insufficient cast technique with secondary fracture displacement, vascular injuries during operative treatment or (low-grade) osteomyelitis of the fracture site are possible causes of posttraumatic nonunion formation. The latter cause is a special kind of pediatric nonunion that has been described in the past as congenital (or infantile) pseudarthrosis and that occurs mostly in the tibia and forearm [1,4].…”

“…To our knowledge and after an extensive literature search, pediatric nonunion after plate osteosynthesis at a metaphyseal level of the forearm has not been described yet. Even in adults, a nonunion after a metaphyseal forearm fracture is seldomly seen due to a good trabecular bone healing and a good nutritional blood supply of the cancellous bone in the metaphysis of the forearm [4,5,[11][12][13][14].…”