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ORIGINAL ARTICLE
Year : 2015  |  Volume : 15  |  Issue : 3  |  Page : 244-248

A morphometric study of tibia and its nutrient foramen in South Indian population with its clinical implications


Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Date of Web Publication2-Sep-2015

Correspondence Address:
Chandni Gupta
Department of Anatomy, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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DOI: 10.4103/1319-6308.164295

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  Abstract 

Objective: The chief blood supply to long bones is through the nutrient arteries, which enter the bone through the nutrient foramina. This supply is important during early stages of ossification, and in various procedures like bone grafts and while doing surgeries for fracture after sports injury. The information of dimensions of tibia segments is vital for forensic experts in order to recognize unidentified bodies. Hence, this study was done to measure various dimensions of the tibia and to analyze the position and the number of nutrient foramina in tibia. Materials and Methods: Fifty adult fully ossified dry tibias were taken and various parameters of the proximal and distal end of both right and left tibia were measured using Vernier caliper to calculate cross-section index in middle, cnemicus index and length-thickness index, foramina index. The position and the number of nutrient foramina in the tibia were also noted down. Statistical analysis of the parameters was done. Results: In our study, the mean length of tibia, anteroposterior diameter at nutrient foramen, transverse diameter at nutrient foramen, length from intercondylar region to nutrient foramen and tibial circumference at nutrient foramen was 37.7, 3.22, 2.21, 13.11 and 8.33 cm. The mean length-thickness index, cross-section index, cnemicus index, and foramina index in our study was 22.08, 70.56, 68.63, and 34.75. Conclusion: The results of this study will be useful for forensic experts in order to identify unidentified bodies and orthopedic surgeons in cases of inserting different implants in the restoration of tibial fractures.

  Abstract in Arabic 

الهدف: رئيس تدفق الدم إلى العظام الطويلة من خلال الشرايين المغذية التي تدخل العظام
من خلال الثقب المغذيات. هذا العرض مهم خلال المراحل المبكرة من التحجر، وفي مختلف
إجراءات مثل ترقيع العظام وأثناء القيام العمليات الجراحية للكسر بعد الإصابات الرياضية. المعلومات
أبعاد قطاعات الساق أمر حيوي لخبراء الطب الشرعي من أجل التعرف على جثة مجهولة الهوية.
وبالتالي، أجريت هذه الدراسة لقياس أبعاد مختلفة من الساق وتحليل الموقف و
عدد الثقب المواد الغذائية في الساق. وكانت tibias الجافة خمسون الكبار متحجرة تماما: مواد وطرق
اتخذت وتم قياس المعلمات مختلفة من الداني والقاصي نهاية كل من اليمين والساق اليسرى
باستخدام رنيه الفرجار لحساب المقطع العرضي المؤشر في الوسط cnemicus مؤشر وطول سمك
مؤشر، مؤشر الثقب. وأشار المركز وعدد من الثقب المواد الغذائية في الساق أيضا
إلى أسفل. تم إجراء تحليل إحصائي للمعلمات. النتائج: في دراستنا، متوسط ​​طول الساق،
قطر الأمامي الخلفي في الثقبة المغذيات، القطر المستعرض في الثقبة المواد الغذائية، وطول من
وكانت المنطقة بين اللقمتين إلى الثقبة المغذيات ومحيط عظام الساق في الثقبة المغذيات 37.7، 3.22،
2.21، 13.11 و 8.33 سم. مؤشر متوسط ​​طول سمك، المقطع العرضي مؤشر، مؤشر cnemicus، و
وكان مؤشر الثقب في دراستنا 22.08، 70.56، 68.63، 34.75 و. والخلاصة: إن نتائج هذه الدراسة
سوف تكون مفيدة لخبراء الطب الشرعي من أجل تحديد جثث مجهولة الهوية وجراحي العظام فيحالات إدخال زراعة مختلفة في استعادة كسور عظام الساق.
الكلمات الرئيسية: مؤشر Cnemicus ومؤشر الثقب، المقطع العرضي مؤشر، طول سمك المؤشر
الثقبة المغذيات، الساق

Keywords: Cnemicus index and foramina index, cross-section index, length-thickness index, nutrient foramen, tibia


How to cite this article:
Gupta C, Nayak N, Kalthur SG, D'Souza AS. A morphometric study of tibia and its nutrient foramen in South Indian population with its clinical implications. Saudi J Sports Med 2015;15:244-8

How to cite this URL:
Gupta C, Nayak N, Kalthur SG, D'Souza AS. A morphometric study of tibia and its nutrient foramen in South Indian population with its clinical implications. Saudi J Sports Med [serial online] 2015 [cited 2019 May 21];15:244-8. Available from: http://www.sjosm.org/text.asp?2015/15/3/244/164295


  Introduction Top


The nutrient artery is the main source of blood supply to a long bone, which enters the bone through the nutrient foramen. This artery is very important for the growth of bone in embryo and fetus as well as during the early ossification phase of bone. [1] During the juvenile period, the nutrient arteries provide 70-80% of the blood supply to long bones, when this supply is gets disturbed, medullary bone ischemia occurs with decreased vascularization of the metaphysis and growth plate. [2] The nutrient arteries enter obliquely in the diaphysis of the long bones, and then divide into ascending and descending branches, once they reach the medullary cavity. [3]

Collective periosteal and medullary blood supply to the bone cortex aids to explain the success of nailing of long bone fractures chiefly in the weight bearing like femur and tibia and positioning grafts of vascularized fibula bone in bony defects due to trauma while playing football or basketball. [4]

Study of comparative association between the length of bone and distance of nutrient foramen from either ends is beneficial in calculating the length of a long bone from a given piece, which is significant in medico-legal and anthropological work. From the length of the long bones stature of an individual can also be found out. [5]

An understanding of the location and the number of the nutrient foramina in long bones is vital in various orthopedic surgical procedures such as joint replacement therapy, fracture repair bone grafts and vascularized bone microsurgery as well as in medico-legal cases. [6]

In free vascular bone grafting, the nutrient blood supply is tremendously significant and must be conserved to promote fracture repair, a good blood supply being essential for osteoblast and osteocyte cell survival, as well as aiding graft healing in the recipient. [5],[7]

Hence, the present study was carried out to measure various dimensions of tibia to calculate the length-thickness index, cross-section index, cnemicus index in tibia and to look for the number of nutrient foramen in tibia, its distance from the upper end and the diameter of shaft at the site of nutrient foramen and to find the foramina index.


  Materials and Methods Top


The study was carried out on 50 dry tibiae (24 right and 26 left). All bones were the adult type and without any signs of erosion. Following parameters were studied on tibia:

  • The length of the tibia
  • The epiphyseal breadth of the proximal tibia
  • Anteroposterior epiphyseal length of the proximal tibia
  • Epiphyseal breadth of the distal tibia
  • Anteroposterior epiphyseal length of the distal tibia
  • Anteroposterior diameter at nutrient foramen
  • Transverse diameter at nutrient foramen
  • Anteroposterior diameter at mid shaft
  • Transverse diameter at mid shaft
  • Length from intercondylar region to nutrient foramen
  • Tibial circumference at nutrient foramen
  • Tibial circumference at the mid-shaft
  • Number of the nutrient foramen
  • Length-thickness index
  • Cross-section index
  • Cnemicus index
  • Foramina index.


All measurements were taken with the help of Vernier caliper [Figure 1], [Figure 2] and [Figure 3].
Figure 1: Measurements done on tibia. (a) Length of tibia. (b) Tibial circumference at mid shaft. (c) Tibial circumference at nutrient foamen. (d) Length from intercondylar region to nutrient foramen

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Figure 2: Measurements done on tibia. (a) Epiphyseal breadth of proximal tibia. (b) Anteroposterior epiphyseal length of proximal tibia. (c) Epiphyseal breadth of distal tibia. (d) Anteroposterior epiphyseal length of distal tibia

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Figure 3: Measurements done on tibia. (a) Transverse diameter at nutrient foramen. (b) Anteroposterior diameter at nutrient foramen. (c) Transverse diameter at mid shaft. (d) Anteroposterior diameter at mid shaft

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The location of all nutrient foramina was determined by calculating a foraminal index (FI) using the formula:

FI = (DNF/TL) × 100 (14,15).

DNF = the distance from the proximal end of the bone to the nutrient foramen.

TL = total bone length.

The location of the foramina was divided into three types according to FI as follow:

  • Type 1: FI up to 33.33, the foramen was in the proximal third of the bone
  • Type 2: FI from 33.33 up to 66.66, the foramen was in the middle third of the bone
  • Type 3: FI above 66.66, the foramen was in the distal third of the bone.


Cross-section index in middle = (transverse diameter in middle of bone/maximum diameter in middle of bone) × 100.

In this formula transverse, diameter in the middle of bone is calculated as the straight distance from the medial tibial border to the interosseous crest at the level of the nutrient foramen. Maximum diameter in the middle of bone measures the straight distance of anterior crest from the posterior surface in the middle of the bone.

Cnemicus index = (transverse diameter at level of nutrient foramen/sagittal diameter at level of nutrient foramen) × 100.

Transverse diameter at the level of the nutrient foramen is the straight distance from the medial border to the interosseous crest at the level of the nutrient foramen. Sagittal diameter at the level of nutrient foramen measures the straight distance of anterior crest from the posterior surface at the level of the nutrient foramen.

Length-thickness index = (maximum girth of shaft/total length of tibia) × 100.

Where maximum girth of the shaft is the maximum circumference of shaft wherever found. Total length of tibia measures the straight distance from the cranial articular surface to the fibular condyle of tibia, that is lateral condyle to the tip of the medial malleolus.

Statistical analysis was performed for all the parameters. Paired sample t-test was done to see the statistical significance between right and left side.


  Results Top


The mean and range of all the parameters of right and left tibia is shown in [Table 1].
Table 1: Mean and range of all parameters of right and left tibias

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In our study the mean length of tibia, epiphyseal breadth of proximal tibia, anteroposterior epiphyseal length of proximal tibia, epiphyseal breadth of distal tibia, anteroposterior epiphyseal length of distal tibia, anteroposterior diameter at nutrient foramen, transverse diameter at nutrient foramen, anteroposterior diameter at mid shaft, transverse diameter at mid shaft, length from intercondylar region to nutrient foramen, tibial circumference at nutrient foamen and tibial circumference at mid shaft was 37.7, 6.87, 4.55, 4.78, 3.48, 3.22, 2.21, 2.82, 1.99, 13.11, 8.33 and 7.51 cm.

The mean length-thickness index, cross-section index, cnemicus index, and foramina index in the right, left, and total tibias are shown in [Table 2].
Table 2: Various index values in right, left and total tibias

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The mean length-thickness index, cross-section index, cnemicus index, and foramina index in our study was 22.08, 70.56, 68.63, and 34.75.

There was no statistical significance between any parameters of the tibia on both right and left side.

In all tibias, there was only one nutrient foramen present in our study. In our study, we got 17 tibia (34%) in which the foramina was in the proximal third of bone and 33 (66%) where foramina was in the middle third of the bone. There were no foramina in the distal third of the bone in our study.


  Discussion Top


The chief blood supply to long bones occurs through the nutrient arteries, which enter through the nutrient foramina. The supply is crucial during the initial phase of ossification and in techniques such as bone graft, tumor resections, traumas and in transplant procedure in orthopedics. [4]

Bhatnagar et al. and Tejaswi et al. found in 57 (95%) and 94.87% tibiae there were 1 foramen and 3 (5%) and 1.28% tibiae there were 2 nutrient foramen. They also found that in 57 (90.47%) and 148 (94.9%) of tibiae the foramina was in the proximal third of bone and 6 (9.52%) and 8 (5.1%) of tibiae it was in the middle third of the bone. There were no foramina in the distal third of the bone in both their study. [4],[8] In our study, we found that in all tibias there was only one nutrient foramen. We got 17 tibia (34%) in which the foramina was in the proximal third of bone and 33 (66%) where foramina was in the middle third of the bone. There were no foramina in the distal third of the bone in our study also. Tejaswi et al. also found triple foramen in 3.84% of the tibiae. [8]

Murlimanju et al. found that 98.6% of tibiae showed single foramen and in 1.4% of the cases, the foramen was absent. The mean FI was 32.5 in their study. They found that 98.3% of the tibial foramina were in the 2/5 th region of the bone. While in our study the mean FI was 34.75. [9]

Kumar et al. found that of the 30 tibia, all showed single nutrient foramen which was limited to the upper 1/3 of the shaft and all were directed downwards. [10]

Bokariya et al. found the mean of cross-sectional, cnemicus, length-thickness index for right and left tibias were 102.90, 66.17, 24.21 and 124.31, 67.31, 24.43 respectively. They also found the mean anteroposterior, transverse diameter at the mid shaft on the right and left side as 1.82, 1.78 and 1.88, 1.58 cm. The mean anteroposterior, transverse diameter at nutrient foramen on right and left side as 1.81, 2.75 and 1.88, 2.82 cm. They found the mean circumference of the shaft and mean total length of the tibia on the right and left side as 9.0, 37.13 and 9.25, 37.94 respectively. While in our study, we got mean of cross-sectional, cnemicus, length-thickness index for right and left tibias 72.34, 70.55, 22.21 and 69.39, 66.98, 21.98. Our values of cross-sectional index were lower as compared to their study rest all our values are similar to their study. We found the mean anteroposterior, transverse diameter at the mid shaft on the right and left side as 2.81, 1.95 and 2.82, 2.04 cm. The mean anteroposterior, transverse diameter at nutrient foramen on right and left side as 3.18, 2.13 and 3.26, 2.30 cm. The mean circumference of the shaft and mean total length of the tibia on the right and left side as 8.3, 37.75 and 8.37, 37.68 respectively. [11]

The regions with good blood supply are more quickly cured than those with a reduced blood supply. Because of the absence of nutrient foramina in the distal third of the tibia, fractures in that area tend to show delayed union or malunion. [12]

Therefore, this study supplies the mean values of the different morphometric measurements of the tibia as well as information about its nutrient foramen. Hence, these measurements might help to indicate the characteristic morphological features of tibial segments in our population, and it will also help the orthopedic surgeon to place different implants in the reconstruction of tibial fractures during sports injury.

 
  References Top

1.
Lewis OJ. The blood supply of developing long bones with special reference to the metaphyses. J Bone Joint Surg Br 1956;38-B: 928-33.  Back to cited text no. 1
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2.
Forriol Campos F, Gomez Pellico L, Gianonatti Alias M, Fernandez-Valencia R. A study of the nutrient foramina in human long bones. Surg Radiol Anat 1987;9:251-5.  Back to cited text no. 2
    
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Collipal E, Vargas R, Parra X, Silva H, Sol M. Diaphyseal nutrient foramina in the femur, tibia and fibula bones. Int J Morphol 2007;25:305-8.  Back to cited text no. 3
    
4.
Bhatnagar S, Deshwal AK, Tripathi A. Nutrient foramina in the upper and lower limb long bones: A morphometric study in bones of Western Uttar Pardesh. Int J Sci Res 2014;3:301-3.  Back to cited text no. 4
    
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Longia GS, Ajmani ML, Saxena SK, Thomas RJ. Study of diaphyseal nutrient foramina in human long bones. Acta Anat (Basel) 1980;107:399-406.  Back to cited text no. 5
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Rao VS, Kothapalli J. The diaphyseal nutrient foramina architecture - A study on the human upper and lower limb long bones. IOSR J Pharm Biol Sci 2014;9:36-41.  Back to cited text no. 6
    
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Al-Motabagoni MAH. The arterial architecture of the human femoral diaphysis. J Anat Soc India 2002;51:27-31.  Back to cited text no. 7
    
8.
Tejaswi HL, Shetty K, Dakshayani KR. Anatomic study of nutrient foramina in the human tibiae and their clinical importance. Int J Recent Trends Sci Technol 2014;9:334-6.  Back to cited text no. 8
    
9.
Murlimanju B, Prashanth K, Prabhu LV, Chettiar GK, Pai MM, Dhananjaya K. Morphological and topographical anatomy of nutrient foramina in the lower limb long bones and its clinical importance. Australas Med J 2011;4:530-7.  Back to cited text no. 9
    
10.
Kumar S, Kathiresan K, Gowda MS, Nagalaxmi. Study of diaphysial nutrient foramina in human long bones. Anat Karnataka 2012;6:66-70.  Back to cited text no. 10
    
11.
Bokariya P, Sontakke B, Waghmare JE, Tarnekar A, Tirpude BH, Shende MR. The anthropometric measurements of Tibia. J Indian Acad Forensic Med 2012;34:322-3.  Back to cited text no. 11
    
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Trueta J. Blood supply and the rate of healing of tibial fractures. Clin Orthop Relat Res 1974;105:11-26.  Back to cited text no. 12
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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