Variations of Nutrient Foramen of Femur and its Clinical Implications
Introduction: Nutrient foramen is the largest opening on the shaft of the femur that conveys nutrient artery into the marrow cavity. Knowledge on locations of nutrient foramina is essential during surgical procedures as well as to rule out if the fracture line passes through the foramina. The purpose of the study was to determine the number and position of nutrient foramina in relation to length and topography of the femur. Methods: The study model was descriptive, cross-sectional study that included 151 femurs (71 right and 80 left side). The total number, location, and direction of nutrient foramina were investigated. Total length of femur and distance of foramen from the proximal end was measured with the 500mm 20" Digital Vernier Nib Jaw Caliper Metric/ Imperial Machine-DRO and finally Foraminal Index was calculated. Results: The analysis revealed 119(78.81%) of the femurs with single nutrient foramen, 31(20.52%) with double and 1(0.67%) with triple nutrient foramina. Foraminal Index II was found in 74(86.05%) on right side and 90(91.84%) on left side. The most common location of nutrient foramen was the medial lip of linea aspera (n= 77, 41.85%). All of the foramina were directed towards the proximal end. Conclusion: The present study has reported the majority of nutrient foramina located in the middle third of femur along the linea aspera. Thus, linea aspera should not be stripped off during surgical procedures to avoid damage to the nutrient arteries.
Standring S. Gray’s Anatomy. 40th ed. Churchill: Livingstone Elsevier; 2008.
Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.
Filipowska J, Tomaszewski KA, Niedzwiedzki L, Walocha JA, Niedzwiedzki T. The role of vasculature in bone development, regeneration and proper systemic functioning. Angiogenesis. 2017;20:291–302. PMID: 28194536 DOI: https://doi.org/10.1007/s10456-017-9541-1
Xue Z, Ding H, Xu H, An Z. An anatomical study of the nutrient foramina of the human humeral diaphysis. Med Sci Monit. 2016;22:1637-45. DOI: https://doi.org/10.12659/msm.898361
Ambekar SA, Surke SB. Diaphyseal nutrient foramen of lower limb long bones: variations and importance. Int J Anat Res. 2016;4(3):2684- 8. DOI: http://dx.doi.org/10.16965/ijar.2016.306
Sendemir E, Cimen A. Nutrient foramina in the shafts of lower limb long bones: situation and number. Surg Radiol Anat. 1991;13(2):105-8. DOI: https://doi.org/10.1007/BF01623881
Afzal E, Khan S, Siddiqui N. Diaphyseal nutrient foramina in dried human adult long bones of lower limb in Pakistan. J Ayub Med Coll Abbottabad. 2017;29(4):623-5. Available from: https://bit.ly/35xSzqa
Oyedun OS. Morphometric study of diaphyseal nutrient foramen in dried Nigerian femurs: Implications for microvascular bone graft. Adv Life Sci Technol. 2014;23:91-6. Available from: https://bit.ly/33dTDxQ
Hughes H. The factors determining the direction of the canal for the nutrient artery in the long bones of mammals and birds. Acta Anat (Basel). 1952;15:261–80. DOI: https://doi. org/10.1159/000140748
Gupta AK, Ambekar MN. Study of nutrient foramina in adult human femur bones. JNGMC. 2016;14(2):44-9. DOI: https://doi.org/10.3126/ jngmc.v14i2.21538
Seema, Verma P, Mahajan A, Gandhi D. Variation in the number and position of nutrient Foramina of long bones of lower limb in North Indians. Int J Anat Res. 2015;3(4):1505-9. DOI: http://dx.doi.org/10.16965/ijar.2015.285
Deswal A, Srivastava SK, Saxena A, Bala A. Morphometric study of nutrient foramina in human femur bone. GJRA. 2017;6(7):4-6. Available from: https://bit.ly/2OI1Epd
Vinay G, Mangala Gowri S. Anatomical study of the nutrient foramen of lower limb long bones in South Indian population. Indian J Clin Anat Physiol. 2017;4(2):222-4. DOI: https://doi. org/10.18231/2394-2126.2017.0054.
Krishna S, Kumar P, V S, V R. Morphologic and morphometric study of the nutrient foramina in dry human femur bones of Telangana region. Int J Anat Res. 2016;4(2):2464–8. DOI: http:// dx.doi.org/10.16965/ijar.2016.239
Mazengenya P, Fasemore MD. Morphometric studies of the nutrient foramen in lower limb long bones of adult black and white South Africans. Eur J Anat. 2015;19(2):155–63. Available from: https://bit.ly/2DcllAw
Poornima B, Angadi A. A study of nutrient foramina of the dry adult human femur bones. Int J Biomed Res. 2015;6(6):370-3. DOI: https:// doi.org/10.7439/ijbr.v6i6.2102 Available from: https://bit.ly/2qwWXH4
Sharma M, Sharma T, Wadhwa A, Kaur J. Morphological variations of nutrient foramina in lower limb long bones. Int J Med Dent Sci. 2015;4(2):802-8. Available from: https://bit. ly/35pXF7u
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