Morphometrical and Topographical Anatomy of Position of Nutrient Foramen on Fully Ossified Left Femur

The femur is supplied by nutrient artery which enters the bone obliquely through the nutrient foramen, which is directed away from the growing end. Henderson reported that the position of nutrient foramen are variable and may alter during the growth.1 It is important that the arterial supply be preserved in free vascularized bone grafts, so that the osteoblasts and osteocytes survive. When the bone graft is taken, the vascularization of the remaining bones has to be considered. Since there are few reports available about the position of nutrient foramen of the femur, the aim of the present study was to find out the topographic anatomy and morphometry of position of nutrient foramen of fully ossified left femur which may help the Abstract Background: The femur is the typical long bone of lower limb which extends from the pelvis to the knee. It forms the skeleton of the thigh, bears body weight, supports movement of legs; provide attachment to muscles, form blood cells and acts as a store house for calcium and phosphate. The nutrient foramina are cavities that conduct the nutrient arteries and the peripheral nerves. The majority blood supply for femur originates from the nutrient arteries, mainly during the growing period and during the early phase of ossification. In bone grafts the nutrient blood supply is crucial and it should be preserved in order to promote the fracture healing. Objective: The anatomy of nutrient foramen of femur is very essential for orthopedic & vascular surgeons as well as to radiologists for planning of treatment. Materials and method: This cross sectional study was carried out in the department of Anatomy, Sir Salimullah Medical College, Dhaka, Bangladesh from July 2011 to June 2012. The study comprised 199 fully ossified left sided dry femur of both sex (n=89 male, n=110 female). Sampling technique was purposive. Morphometric and topographic study was carried out on all samples by direct physical and photographic methods. Results: The most common position of nutrient foramen on the shaft of femur was found on the middle 1/5th in both male and female femur (50.78% in male and 56.86% in female respectively). Conclusion: The anatomical knowledge about this study might be useful in certain surgical procedures as well as micro vascular bone transfer to preserve the circulation.


Introduction
The femur is supplied by nutrient artery which enters the bone obliquely through the nutrient foramen, which is directed away from the growing end.Henderson reported that the position of nutrient foramen are variable and may alter during the growth. 1 It is important that the arterial supply be preserved in free vascularized bone grafts, so that the osteoblasts and

Discussion
The diaphysis of femur is irrigated by one or more nutrient arteries that pierce the compact bone and divide in the medullary cavity into ascending and descending branches while accompanied by the terminal branches of numerous metaphyseal and epiphyseal arteries. 5The transplant of the femoral diaphysis can use, the deep femoral artery, if the lateral circumflex femoral artery is protected. 6According to another researcher it was observed the position of nutrient foramen on the shaft of fully ossified left femur on the upper most 1/5 th in 10.60% male, 9.60% female, on the upper 1/5 th in 25.40% male, 26.40% female, on the middle 1/5 th in 50.10% male, 51.10% female samples, on the lower 1/5 th in 8.90% male, 6.90% female samples, on the lower most 1/5th in 5.00% male and 6.00% female samples. 7Above report is similar to our study.In another study they observed the position of nutrient foramen on shaft of male femur on the upper most 1/5 th in 20.20% male, 21.60% female samples, on the upper 1/5 th in 33.80% male, 32.40% female samples, on the middle 1/5 th in 25.50% male, 20.30% female samples, on the lower 1/5 th in 18.50% male, 22.70% female samples and the lower most 1/5 th

Results
Table I shows the distribution of position of nutrient foramen between male and female.It was found that the most common position was on the middle 1/5 th both in male and female femur (50.78% male and 56.86% female) followed by upper 1/5 th and the lowest proportion on lower-most 1/5 th in both sex.

Position of nutrient foramen
Upper-most 1/5 th

Materials and method
This cross sectional study was conducted in the department of Anatomy in Sir Salimullah Medical College, Dhaka, Bangladesh from July 2011 to June 2012 on 199 fully ossified left sided dry femur.Among those 89 were of male and 110 were of female skeleton.The position of nutrient foramen on the shaft of left femur was measured directly using digital slide calipers and scale, and indirect photographic measurement was done by digital camera and computer.All measurements were recorded in metric unit-centimeters (cm).Data were recorded and expressed as proportions.

Procedure for identifying the position of nutrient foramen on shaft of femur
Fig1: Procedure for identifying the position of nutrient foramen (NF).
Only diaphyseal nutrient foramens were observed in all the bones.The shaft of the femur was divided into five equal parts.An elastic rubber band was applied around the proximal end of the nutrient foramen and photograph was taken with digital camera.The positions of nutrient foramens were observed physically and topographically. 4n 2.00% male and 3.00% female samples. 8This observation is not consistent with ours.These discrepancies may be due to influence of genetic factor and food habit on growth pattern of the femur of study populations. 9 The present study was conducted with an attempt to find out the position of nutrient foramen of left femur which might help the anatomist, orthopedic surgeon and vascular surgeon for planning of treatment in Bangladeshi population.Further large scale research with larger sample size, wider age group and radiographic study is recommended.

Table I : Position of nutrient foramen in male and female femur
1. Assistant professor, Department of Anatomy, Delta Medical College, Dhaka, Bangladesh. 2. Professor & Head, Department of Anatomy, Sir Salimullah Medical College, Dhaka, Bangladesh.Correspondence: Dr. Md.Shahajahan Chowdhury.e-mail: shahajahan001@yahoo.com Original Article Delta Med Col J. Jan 2013; 1(1) age of twenty-five years.So it achieves its adult form and fixed measurement after this age. 2 According to reported observation, left lower limb is functionally dominant in majority of human beings.3Onthis basis left sided adult femur was considered as sample.