Anatomic characterization of the femoral nutrient artery: Application to fracture and surgery of the femur

Abstract

The localization of nutrient foramina and direction of nutrient canals have been studied. However, information about the origin and extraosseous course of nutrient arteries is lacking in some types of long tubular and irregular bones. Thus, we aimed to reexamine the origin and course of the femoral nutrient artery (FNA) through cadaveric dissection to clarify its anatomic characteristics. Sixty thighs were collected from 57 cadavers. To fix the cadavers and visualize the small arterial branches, 10% formalin was injected from the femoral artery, followed by an injection of acrylic ink. The arterial tree in the posterior part of the thigh was recorded by line drawings. The femur received single or double FNAs via the femoral nutrient foramina, which were on and along the linea aspera. In cases with single FNA (41 of the 60 thighs), it typically arose from the four parts of the profunda femoris system: profunda femoris artery between the origins of the third and fourth perforating arteries; second perforating artery; third perforating artery; and terminal branch. In cases with double FNAs (remaining 19 thighs), the superior FNA typically arose from the second perforating artery, and the inferior FNA arose from the terminal branch of the profunda femoris artery and popliteal system. FNAs are described as branches of the perforating arteries in Terminologia Anatomica and anatomy textbooks. However, we found that FNAs also frequently arose from the profunda femoris artery and popliteal system, in addition to the perforating arteries. Clin. Anat. 33:479-487, 2020.

Injury of the Tibial Nutrient Artery Canal during External Fixation for Lower Extremity Fractures: A Computed Tomography Study

“…The tibial diaphysis has a poor extraosseous blood supply at its posterior aspect, leaving the TNA to be the key player for providing adequate blood supply, especially in the context of fracture healing when increased blood supply is needed most [ 7 ]. Injury to the nutrient arteries of long bones has thus been reported as a risk factor for delayed or non-union due to the depression of callus formation [ 2 , 3 , 4 , 7 , 8 , 9 , 10 ]. In addition, the integrity of the TNA is very important during childhood, and its injury could lead to growth impairment due to a disruption of blood supply to the epiphyseal plate, as it provides more than 70% of intraosseous blood supply [ 4 , 11 ].…”

“…In addition, the integrity of the TNA is very important during childhood, and its injury could lead to growth impairment due to a disruption of blood supply to the epiphyseal plate, as it provides more than 70% of intraosseous blood supply [ 4 , 11 ]. As a result of this artery’s significance, the preservation of the TNA during surgical procedures has been previously advocated [ 3 , 9 , 10 ].…”

The human clavicle's nutrient foramen's prevalence, number, location, and direction: A systematic review and meta-analysis

“…28 However, this is not supported by epidemiological data showing that non-union rates are highest in the lateral third segment (28e44%), 29 compared to the middle-(11e16.5%) 29 and medial third segment (5%). 30 This apparent discrepancy between fracture patterns and non-union are similarly observed for the tibia, 31 while injuries near the anterior humeral, 32 femoral, 33 and fifth metatarsal 34 nutrient artery is in contrast believed to attribute to non-union. One explanation might be that clavicle fracture healing depends on its periosteal network rather than its rare and weak intraosseous nutrient branches.…”

Deep Vein Thrombosis after Cement Intravasation during Hip Hemiarthroplasty

“…This occurs when the pressurization of cement through the medullary canal backflows through the nutrient vessels. The nutrient vessels are the primary vascular supply for the femoral shaft and often originate from the profunda femoris [4,7]. Although it is often asymptomatic and harmless, cement leaving the medullary canal can cause unintended consequences.…”