A STUDY OF THE NUTRIENT FORAMINA IN DRY HUMAN TIBIA BONES OF TELANGANA REGION

Address for Correspondence: Dr. Udaya Kumar P, Associae Professor, Department of Anatomy, Mamata Medical College, Rotary Nagar, Khammam. Telangana – 507002, India. Mobile No: 09133000191 E-Mail: udaymmc7@gmail.com Introduction: Nutrient canal opens externally at certain location on the bone surface, called nutrient foramina. Nutrient artery plays major role in bone formation during growth of the embryo. Aim: The aim of the present study is to determine the number, position, size, direction of the nutrient foramina and the Foramen Index of the human dry tibia bones Materials and Methods: The study was carried out in 74 right sided and 77 left sided dried human tibia bones of unknown age and sex in telangana population. Foramen index (FI) was calculated using the formula: FI = (Distance of nutrient foramina from upper end/Total length) x 100. Results: In the present study almost all of the bones showed nutrient foramina away from the knee but two left sided and three right sided tibia bones defied the growing end theory. The total length of the tibia, in the present study, is observed to be 37.26 ± 2.83 on right side and 37.54 ± 2.30 on left side, with foramen Index of 32.09 ± 3.76 cm on right side, and 32.12 ± 3.13 left side. Nutrient foramina are located predominantly in the upper third of the bone. No foramina were observed in lower third of the bones. On an average 79% of foramina are located below the soleal line. In the present study, only two right sided tibia bones, showed three nutrient foramina. Two nutrient foramina were observed in 13.51% right sided and 10.39% left sided tibia. Conclusion: Preserving the nutrient arterial blood supply is vital in cases of bone grafting, fractures healing, joint replacement therapy and vascularised bone micro surgeries. So the thorough knowledge of morphology and morphometry of nutrient foramina is now a necessity.

growing end of the bone, but it is not always true in case of mammals [5,6].In cases of bone grafting, fracture healing, joint replacement therapy and vascularised bone micro surgeries, preserving the nutrient arterial blood supply is vital [6,7].
Aim: The aim of the present study is to determine the number, position, size, direction of the nutrient foramina and the Foramen Index of the human dry tibia bones

MATERIALS AND METHODS
The study was carried out in the department of Anatomy, Mamata Medical College, Khammam, Telangana.In the present study, 74 right sided and 77 left sided dried human tibia bones of unknown age and sex without any pathological changes were taken into consideration.Required measurements of the bone were taken using an osteometric board.Foramen index (FI) was calculated using the formula: FI = (DNF/TL) x 100 (Hughes 1952 [8]; Shulman 1959 [9]).DNF = the distance from the proximal end of the bone to the nutrient foramen.

DISCUSSION
population with foramen index is tabulated to be compared.(Table No. 3).Dr Ales Hrdlicka [20], in his anthropological study of 2000 tibia, observed that the left tibia is slightly longer on an average.The same is found in the present study coinciding with the observation of Dr Ales Hrdlicka and most of the authors mentioned in the table No. 3. Regarding the number of nutrient foramina in tibia, many researchers reported the double and tribple diaphysial nutrient foramen on the tibia as a rare occurrence (Table No. 4).In the present study, only two right sided tibia bones of total 74, showed three nutrient foramina.Two nutrient foramina were observed in 13.51% right sided and 10.39% left sided tibia.Roopam et al [21] and Prashanth et al [22] reported absence of nutrient foramina in 3.7% and 1.4% of tibia respectively.Patake [23] opined that, in the absence of nutrient foramen, the bone is likely to be supplied by periosteal arteries.Location of the nutrient foramen in tibia was observed to be consistent by many authors i.e. in the upper one third and on the posterior surface.In the present study also nutrient foramina are located predominantly in the upper third of the bone than the middle third.
No foramina of the size greater than 24 gauze were observed in lower third of the bones, which may be the reason for delayed or non-union of fractures in the lower third of tibia.On an average 79% of foramina are located below the soleal line and very less percentage above the Nutrient artery supplies seventy to eighty percent of blood to long bones during childhood [10].In the case of their absence, the vascularisation occurs through the periosteal vessels 11 .Posterior tibial artery gives a nutrient branch to tibia and is the largest of its kind in the body [12].Hemang Joshi [24] opined that the thorough knowledge of nutrient foramina is essential for open reduction of a fracture, to avoid unnecessary injury to the nutrient artery.
In the hemodynamic point of view, all the nutrient arteries course caudally in the embryonic period.Due to unequal growth of the ends of long bones, the direction of the nutrient artery is away from the growing end in limb long bones [13].Henderson RG [5] and Hughes [8] observed that it was not always true in case of mammals.Agarwal et al [14], Vadhel et al [15], Tejaswi et al [16], and Kizilkanat et al [17] reported that the nutrient foramen is directed away from the knee joint.In the present study almost all of the bones showed nutrient foramina away from the knee but two left sided and three right sided tibia bones defied the growing end theory, corroborating with observations by Henderson 5 , Pedzisai et al [18], anjana et al [19].The total length of the tibia, in the present study, is observed to be 37.26 ± 2.83 on right side and 37.54 ± 2.30 on left side, with foramen Index of 32.09 ± 3.76 cm on right side, and 32.12 ± 3.13 left side.The variation in lengths in different soleal line, corroborating with the findings of the authors mentioned in the table no. 5.

CONCLUSION
Preserving the nutrient arterial blood supply is vital in cases of bone grafting, fractures healing, joint replacement therapy and vascularised bone micro surgeries.So the thorough knowledge of morphology and morphometry of nutrient foramina is now a necessity.The present study in the tibia bones adds to the literature available and especially gives insight into the morphometric parameters in the population of Telangana.

INTRODUCTION
International Journal of Anatomy and Research, Int J Anat Res 2017, Vol 5(3.1):4152-57.ISSN 2321-4287 DOI: https://dx.doi.org/10.16965/ijar.2017.271Nutrient foramina allows the nutrient artery to pass through the bone cortex [3].The nutrient artery enters the diaphysis of the long bones obliquely.The point of entrance and angulations are relatively constant [4].Usually, the direction of the nutrient foramina is away from the Nutrient canal opens externally at certain location on the bone surface, called nutrient foramina [1].Apart from the many other small vessels, Nutrient artery plays major role in bone formation during growth of the embryo [2].
TL = total bone length.Number, direction and distribution of the nutrient foramina were observed by Hand lens.Syringe needles of various gauzes were used to measure the size of foramina.Only the foramina on diaphysis and of the size greater than 24 gauze were taken into consideration.a) Size of the 18 gauze needle was considered to be between 1.27 mm or more [>1.27mm].b) Size of the 20 gauze needle was considered to be between 0.90 mm and 1.27 mm [>0.90mm to < 1.27mm].c) Size of the 22 gauze needle was considered to be between 0.71 mm and 0.90 mm [> 0.71mm to < 0.90 mm].d) Size of the 24 gauze needle was considered to be between 0.55 mm and 0.71mm [> 0.55mm to < 0.71 mm].out of 77 bones, sixty nine bones showed single foramen, eight bones showed two foramen (Fig No. 3) and none of them showed three foramen.The nutrient foramen are directed downwards (i.e away from the knee) in almost all the bones except 3 right sided and 2 left sided tibial bones, in which the nutrient foramina is directed towards the knee joint.(Fig No. 2 & 3) Size of foramina, total length of the bone, distance from the upper end to proximal nutrient foramina, foramen index, Segmental position and location of nutrient foramen on the bone are shown in the Table No. 1,2,3, 4 & 5. RESULTS Out of 74 right sided bones, 62 bones have single foramina, 10 bones have two nutrient foramen (Fig No. 1) and in 2 bones showed three nutrient foramen (Fig No. 2).On the left side,

Fig. 1 :
Fig. 1: Right Tibia showing two nutrient foramina, on the soleal line and below the soleal line.

Table 1 :
Showing the size of the nutrient foramen.

Table 2 :
Showing the length of the bone, distance of the proximal nutrient foramina from the upper end and foramen index.

Table 4 :
Showing the percentages of number of nutrient foramina in various studies.Janardhan Rao M. et al.A STUDY OF THE NUTRIENT FORAMINA IN DRY HUMAN TIBIA BONES OF TELANGANA REGION.

Table 5 :
showing the segmental Location of the nutrient foramina (all values are expressed in percentages).