Nutrient artery

Abstract: It is worth repeating that in all of these bones the periosteum with its rich blood supply had been removed. A true picture of the blood supply can only be obtained by keeping this abundant source of arterial blood in mind. The constancy of the main nutrient artery of the humeral shaft is remarkable. It would appear to be prudent to guard against injuring this vessel in operations on the humeral shaft. The danger of damaging this artery will probably be greatest in open reductions of fractures of the mid-shaft of the bone. Fractures through the shaft at the junction of the middle and lower thirds will probably destroy the main nutrient at the time of injury. The upper end of the lower fragment will then depend for arterial blood supply on vessels entering from the periosteum and those ascending from the epicondyles. Extensive stripping of the periosteum of the lower fragment in open reductions in this region would probably be best avoided. The upper half of the shaft has an excellent blood supply from the ascending branch of the main nutrient artery and from the accessory nutrient arteries. This may account for the predilection of secondary malignant deposits for this part of the bone. The main blood supply of the humeral head enters it anterolaterally above the common site of fractures of the surgical neck. Both bone ends thus have a good blood supply. This may account for the rapidity of union of these fractures. However, in operating on this region, whether for repair of rotator-cuff injuries or for open reduction of fracture-dislocations of the surgical neck, it is perhaps worth while bearing in mind that the main blood supply of the head enters it via the upper end of the bicipital groove or via the adjacent parts of the greater and lesser tuberosities. If damage to these vessels is avoided the viability of the humeral head may be preserved. The importance of preserving muscular and ligamentous attachments when operating on the lower end of the humerus is well known. The size of the posterior arteries entering the epicondyles and condyles is, however, worth bearing in mind. If damage to these posterior vessels is avoided in operations on fractures in this region, the viability of the bone fragments may well be preserved and subsequent degenerative changes in the elbow joint may be avoided. The intramedullary course of the nutrient arteries (Fig. 16) must mean that they will be destroyed by the insertion of intramedullary nails. If at the same time an open reduction of the fractured shaft is performed, periosteal stripping of the bone ends will be inevitable. The blood supply of the shaft would then be unduly jeopardized. Both the branches of the main and accessory nutrient arteries in the medulla and the only possible local collateral circulation, the periosteal vessels, would be destroyed.

Abstract: 1. The arterial supply of the upper end of the femur has been studied in twenty-four children and twenty adults. 2. The arterial system was demonstrated by injection of radio-opaque material, with Spalteholz9 method of clarification, and histological section of the neck and ligamentum teres. 3. The upper end of the femur is supplied by the nutrient artery of the shaft, the retinacular vessels of the capsule, and the foveolar artery of the ligamentum teres. 4. The retinacular vessels consist of three separate groups: postero-superior, posteroinferior, and anterior. These vessels are the chief supply to the epiphysis and femoral head at all ages. 5. The foveolar artery constitutes a small and subsidiary blood supply to the femoral epiphysis. In this series, it penetrated the cartilaginous or osseous head in 33 per cent. of young specimens and 70 per cent. of adult specimens. The foveolar vessels increase in size with age. 6. The site of the vascular pathology in various lesions of the femoral head is considered.

Abstract: The blood supply of healing undisplaced closed fractures of the radius and tibia in adult mongrel dogs was studied by means of microangiograms and histological preparations. The microangiograms were prepared from decalcified longitudinal slices across the fracture site, one millimeter in thickness. The corresponding histological preparations were made from the same slices of tissue. The vascular pattern at the site of fracture, at intervals from one day to eight weeks after fracture, was compared with the normal vascular pattern. Immediately after fracture there was a marked opening up of the existing arterial tree. With the advancement of healing, both medullary and periosteal circulations increased greatly by the development of new blood vessels; but the medullary arterial system, when intact, played the major role in the supply of blood to the uniting callus and in the revascularization of the necrotic cortex at the fracture site. The ascendency of the medullary blood supply increased as healing progressed. In the dog the normal configuration of the blood supply of the compacta is similar to that in man; the inner two-thirds of the cortex is supplied by branches of the nutrient artery. Our experimental findings in the dog support clinical experience. The periosteal circulation of long bones can take over when the medullary circulation has been interrupted by displacement of the fracture fragments or by surgery—as will be described in subsequent reports of experiments in progress. However, the medullary arterial supply, when available, dominates the vascular picture in rapid fracture healing.

Abstract: The extraosseous and intraosseous vascular anatomy to the fifth metatarsal as visualized in a group of below-the-knee amputation specimens has been described. The extrinsic circulation to the area is provided by the dorsal metatarsal artery, the plantar metatarsal arteries, and the fibular plantar marginal artery. These three source arteries supply branches to the metatarsal and adjacent joints. The intraosseous vascularity consists of a periosteal plexus, a nutrient artery, and a system of metaphyseal and capital vessels.