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Morphological and morphometric study of tibial nutrient foramen.

INTRODUCTION: Tibia (Also called as shin bone or shank bone) is the larger and stronger of the two bones in the leg present on the medial aspect. It is named after the Greek word "Aulos flute" recognized as one of the strongest weight bearing bone of the body. The role of nutrient foramina in the nutrition and growth of the bones is evident from the term 'nutrient' itself. (1) Knowledge of the position of nutrient foramina can be useful in surgical procedures. (2) The surgeon must also possess a detailed knowledge of the anatomy of the part on which he is to operate, since the success of these operations, depends to a large extent, on minimal interference with the blood supply of the bone. (3) In medicolegal practice, it is possible to estimate the total length of bone, if the ratio between the total length and the distance of nutrient foramen from both the ends is known. This is particularly important in incomplete bones broken at one end. Similarly, the height of an individual can be reconstructed from the length of bone like tibia. (4)

MATERIAL AND METHODS: The present study was conducted in the Department of Anatomy, Government medical college, Jammu. Material for the study comprised of 70 dry Tibiae of adult and unknown sex available in the department of Anatomy. Bones were labelled from 1 to 70. Dry bones which were thoroughly cleaned and complete in all the aspects were included in this study. Broken bones with any kind of deformity were excluded. The nutrient foramen on the posterior surface of the tibia was noted and counted. It was observed, whether it was in the upper half of the tibia, middle half or junction between the upper half and middle half of the tibia. The situation of nutrient foramen in relation to vertical line on posterior surface was noted, that is whether it was medial or lateral to the vertical line the direction of nutrient foramen was observed and the distance of nutrient foramen from the upper and lower end of the tibia was measured by a scale.

OBSERVATION: All the bones had a single nutrient foramen (table- 1).The nutrient foramen is situated in the upper third of the posterior surface of tibia in all. (Table-2) Most of them lie lateral to the vertical line on the posterior surface (table-3).In all the 70 bones the nutrient foramen was directed downwards. The mean distance of nutrient foramen from the upper end of tibia was compared. On the right side it was 118.23 [+ or -] 7.69mm (Range = 99 -132mm). The corresponding values on left side was 114.34 [+ or -] 9.42mm (Range =100 -130mm). When compared between two sides it was more on right side (Table 4). The mean distance of nutrient foramen from the lower end of tibia was also compared in the present study (Table 4). On the right side, it was 255.83 [+ or -] 12.19mm (Range =235-280 mm). The corresponding values on the left side was 255.43 [+ or -] 15.97mm (Range= 225-285mm). When compared between the two sides the distance was more on the left side. If we have a closer look at table 4, it can be deduced that distance of nutrient foramina from the lower end of tibia is more than its distance from the upper end of the tibia. (Bar Diagram)

DISCUSSION: The number of nutrient foramina on the posterior surface of shaft in present study was found to be single. Earlier studies by Chattarapati & Misra, (4) Mysorekar, (2) Longia et al, (5) Collipal et al, (6) and Tejaswi et al, (7) have also found that in majority of bones single nutrient foramina was present. Thus our study is in agreement with them. . In the present study nutrient foramen was situated in upper one third of posterior surface of all 70 tibiae. Authors like Mysorekar, (2) longia et al, (5) and Tejaswi et al, (7) also found it to be in upper 1/3rd of posterior surface. Thus our study is in consonance with them.

The nutrient foramen was situated lateral to vertical line in majority of bones in the present study. Similar to our observations, a number of authors like Chattrapati & Misra, (4) Mysorekar, (2) Kate, (1) and Longia et al. (5) also found it to be mostly situated lateral to vertical line.

Direction of nutrient foramina was found to be directed downwards in case of the present study, as its relationship with the growing end of long bones has been enunciated in the Wolff's law that it seeks the elbow and flees the knee. Tejaswi et al. (7) also found it to be directed downwards. Only Longia et al, (5) encountered 3.5% of tibiae disobeying this law. According to Hughes. (8) There are variations in the direction of the nutrient foramina in many tetrapods and also similarity in the nutrient foraminal pattern in mammals and birds.

The mean distance of nutrient foramina from the upper end of tibia and from the lower end of tibia was more on the right side. Earlier Chattrapati & Misra,M had measured distance of nutrient foramina from the both ends of tibia in Gujarat population and found it to be more on the right side which is in accordance with our study.

SUMMARY: The present study was conducted on 70 adult human tibiae, 35 each on right and left side. Different morphological features of nutrient foramen were looked for and morphometrical parameters were measured. It was concluded that all the bone of the present study depicted only one nutrient foramen situated on the upper third of the bones and directed downwards. In majority of the bones, it was situated lateral to the vertical line. The distance of nutrient foramen from both the upper and lower end was more on the right side.

The present study gains clinical significance as the anatomy of the nutrient foramen especially its consistent location and the large size becomes important because fractures involving upper third of tibia through the nutrient canal which disturbs the blood supply to the shaft. This invariably results in delayed union. During transfer of a large, straight, high density cortical bone graft, its predictable location favours safe manipulation and so damage to nutrient vessels during surgical procedure is avoided.

DOI: 10.14260/jemds/2015/930

REFERENCES:

(1.) Kate BR. Nutrient Foramina in human long bones. J Anat Soc Ind 1971; 20 (3):139-145.

(2.) Mysorekar VR. Diaphyseal nutrient foramina in human long bones. J Anat 1967; 101 (4):813-822.

(3.) Laing P.G. The blood supply of the femoral shaft; an anatomical study J Bone joint Surg B 1953; 35: 462-466.

(4.) Chattrapati DN and Misra BD. Position of the nutrient foramen on the shafts of human long bones. J Anat Soc Ind 1967; 16: 54-63.

(5.) Longia GS, Ajmani ML, Saxena SK, and Thomas RJ. Study of the diaphyseal nutrient foramina in human long bones. Acta Anat 1980; 107:399-406.

(6.) Collipal E, Vergas R, Parra X, Silva H, and Sol MD. Diaphyseal nutrient foramina in the femur, tibia, and fibula bones. Int J Morphhol 2007; 25 (2):305-308.

(7.) Tejaswi HL, Shetty K and Dakshayani KR. Anatomic study of the nutrient foramina in the human tibiae and their clinical importance. Int J Recent trends in Sci and Tech 2014; 9 (3):334-336.

(8.) Hughes H. The factors determining the direction of the canal for the nutrient artery in the long bones of mammals and birds. Acta Anat 1952; 15:261-280.

Narinder Singh [1], Rachna Magotra [2], Arban Kumar [3], Ashwani Kumar Sharma [4]

AUTHORS:

[1.] Narinder Singh

[2.] Rachna Magotra

[3.] Arban Kumar

[4.] Ashwani Kumar Sharma

PARTICULARS OF CONTRIBUTORS:

[1.] Associate Professor, Department of Anatomy, Government Medical College, Jammu.

[2.] Assistant Professor, Department of Anatomy, Government Medical College, Jammu.

[3.] Post Graduate Student, Department of Anatomy, Government Medical College, Jammu.

[4.] Lecturer, Department of Anatomy, Government Medical College, Jammu.

FINANCIAL OR OTHER COMPETING INTERESTS: None

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Rachna Magotra, 242/7, Channi Himmat, Jammu-180015. E-mail: drmagotrarachna@gmail.com

Date of Submission: 12/04/2015.

Date of Peer Review: 13/04/2015.

Date of Acceptance: 28/04/2015.

Date of Publishing: 05/05/2015.
Table 1: Comparison of No. of nutrient foramina

                    No. of bones with nutrient foramina

Author      Race       One           Two          Three

                    Rt.    Lt.    Rt.    Lt.    Rt.    Lt.

Present    North     35     35     -      -      -      -
study      Indian

Table 2: Comparison of situation of nutrient foramina in
relation to length of tibia

                        Situation of nutrient foramina

                    Upper1/3rd    Middle1/3rd    Junction of
                                                 upper 1/3rd
                                                  and middle
                                                    1/3rd

Author      Race    Rt.    Lt.    Rt.     Lt     Rt.    Lt.

Present    North     35     35     -       -      -      -
study      Indian

Table 3: Comparison of Situation of Nutrient Foramina in
Relation to Vertical Line

                    Situation of nutrient foramina

                     Lateral to      On vertical     Medial to
                    vertical line        line       vertical line

Author      Race     Rt.     Lt.     Rt.     Lt.     Rt.     Lt.

Present    North     31      32       -       -      04      03
study      Indian

Table 4: Comparisons of Distance of Nutrient Foramina From the
Upper End and Lower End of Tibia

                                 Mean [+ or -]
                                     SD(n)

Distance     Author     Race          Rt.
from (mm)

Upper end    Present   North    118.23 [+ or -]
              study    Indian        7.69

Lower end    Present   North    255.83 [+ or -]
              study    Indian        12.19

              Mean [+ or -]         Range
                  SD(n)

Distance           Lt.           Rt.       Lt.
from (mm)

Upper end    114.34 [+ or -]   99-132    100-130
                  9.42

Lower end    255.43 [+ or -]   235-280   225-285
                  15.97

Fig. 1: Comparison of Distance of Nutrient Foramina from the Upper
End and Lower End of Tibia

        RIGHT    LEFT
FROM
UPPER
END     118.23   114.34

FROM
LOWER
END     255.83   255.43

Note: Table made from bar graph.
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Article Details
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Title Annotation:ORIGINAL ARTICLE
Author:Singh, Narinder; Magotra, Rachna; Kumar, Arban; Sharma, Ashwani Kumar
Publication:Journal of Evolution of Medical and Dental Sciences
Date:May 7, 2015
Words:1608
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