Diaphyseal Nutrient Foramen of Lower Limb Long Bones: Variations and Importance

Abstract

Background:The nutrient foramen (NF) is the largest of the foramen present on the shaft of long bone allowing nutrient artery to enter the bone. These arteries are important during active growth period of embryo and fetus and during the early phases of ossification. They provide 70-80% of the interosseous blood to long bones. The context and purpose of the study:The study was conducted on 156 long bones of lower limb available in the department of anatomy, Government medical college, Aurangabad.The aim of the study was to note the morphology and variations of nutrient foramen in human adult lower limb long bones and to discuss its clinical importance. We observed only diaphyseal nutrient foramens of these bones for size and number. Size of foramens were measured using hypodermic needle and foramen were classified as secondary (SF) or dominant (DF). Number of foramens or their absence was noted. Distance of nutrient foramen (DNF) was measured using Vernier caliper from highest point of head of femur and fibula to foramen and from center of tibial condyles on posterior aspect of tibia. Total length of bone (TL) was measured using standard osteometric board. The location of all nutrient foramen in upper, middle or lower third of bone was determined by calculating a foraminal index using Hughes formula. Results:We observed that maximum tibia had single foramen followed by fibula and femur. We found maximum five foramens on two left femurs. One femur had secondary foramen on anterior surface. Nutrient foramens were totally absent in six fibulas. According to foraminal index, tibia had maximum nutrient foramen in upper third of shaft while femur and fibula had them on lower third. Potential implications:On radiograph, nutrient foramen mimics longitudinal stress fracture or may be misdiagnosed as lytic bone lesions like osteoid osteoma. Precise knowledge of nutrient foramen and its variations is necessary for doctors to predict prognosis of grafts, tumors, fractures of bones and also useful for anthropologist during interpretation of height from a fragment of bone. Conclusions:The maximally observed position of nutrient foramen is in middle third of the shaft of femur and fibula while upper third of shaft in tibia. Knowledge of which is important clinically for proper diagnosis and planning of surgery and also to predict the prognosis.

Morphometric Study of Nutrient Foramen in the Long Bones of Lower Limb

“…Mazengenya et al [14] has reported the occurrence of 6 nutrient foramina on a single femur. Ambekar SA et al [9] has reported the occurrence of 5 nutrient foramina in 2 femur bones and triple nutrient foramina were observed in 26.9% of the femur bones in their study.…”

“…Nutrient foramina which did not allow the passage of a size 24 gauge needle were considered as secondary nutrient foramina. Nutrient foramina which allowed the passage of size 24 gauge needle were considered as dominant nutrient foramina [9]. The direction of the nutrient foramen was assessed by passing a hypodermic needle into the nutrient foramen.…”

“…Abledu JK et al [16] have reported the length of femur to be 44.97 + 2.34cm. Ambekar SA et al [9] has reported the mean femoral length to be 40.79cm.…”

“…Ambekar SA et al [9] has reported the presence of one nutrient foramen in 63.5% of fibulae, two nutrient foramina in 7.7% of fibulae and three nutrient foramina in 1.9% of fibulae. Patel SM et al [18] has reported the occurrence of single nutrient foramen in 80% of fibulae and triple nutrient foramina in 1.3% of fibulae in black South Africans.…”

“…Gupta RK and Kumari GA [19], have reported the nutrient foramina to be commonly located in middle third of tibia. Ambekar SA et al [9] have reported that the nutrient foramina were commonly placed on the proximal third of tibia. Kizilkanat et al [10] have reported that the nutrient foramina were commonly present in middle third of tibia.…”