Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Updated: 6/15/2021

Bone Circulation

0%
Topic
Review Topic
0
0
0%
0%
Flashcards
19
N/A
N/A
Questions
2
0
0
100%
0%
Evidence
1
0
0
0%
0%
Videos / Pods
1
Topic
Images
https://upload.orthobullets.com/topic/9005/images/ephiphyseal blood supply.jpg
https://upload.orthobullets.com/topic/9005/images/venous vascularization of long bone.jpg
  • Introduction
    • Bone receives 5-10% of cardiac output
    • Bones that receive tenuous blood supply
      • scaphoid
      • talus
      • femoral head
      • odontoid
    • Blood supply to long bone comes from three sources
      • nutrient artery system
      • metaphyseal-epiphyseal system
      • periosteal system
  • Nutrient Artery System
    • High pressure system that branches from major systemic arteries
    • Enter the cortex through the nutrient foramen and enter the medullary canal
      • then branch into ascending and descending branches
        • then branch into arterioles and supply the inner 2/3 of mature bone via the haversion system
  • Metaphyseal epiphyseal system
    • Arteries arise from periarticular vascular plexus
      • e.g. geniculate arteries
  • Periosteal System
    • Low pressure system that supplies the outer 1/3 of bone
      • connected by
        • Volkman's artery (perpendicular to long axis)
        • Haversion system (parallel to long axis)
  • Intracortical Vascularization
    • Intracortical vessels travel within canals
      • Primary Haversian canals
      • Secondary Volkmann canals
  • Direction of Arterial Flow
    • Normal intraosseous blood flow rate is 5-20ml/min/100g of bone
    • Mature bone
      • flow is centrifugal (inside to outside)
        • because of high pressure nutrient artery system and low pressure periosteal system
    • Immature bone
      • flow is centripetal (outside to inside)
        • because low pressure periosteal system predominates
    • Factors increasing blood flow
      • hypoxia
      • hypercapnia
      • sympathectomy
  • Direction of Venous Flow
    • Mature bone
      • flow is centripetal (outside to inside)
        • cortical capillaries drain to venous sinusoids, which drain to the emissary venous system
  • Growth Plate
    • Perichondrial artery is the major source of nutrition of the growth plate
  • Pathoanatomy
    • Fractures
      • patterns of blood flow following fracture
        • immediate phase
          • initial decrease in blood flow after fracture
          • flow is centripetal (outside to inside)
            • because high pressure nutrient artery system is disrupted
            • low pressure periosteal system predominates
      • hours to days
        • increase in blood flow (regional acceleratory phenomenon)
        • peaks at 2 weeks and returns to normal in 3-5 months
    • Intramedullary nails
      • unreamed intramedullary nails preserve endosteal blood supply
      • reaming devascularizes inner 50-80% of the cortex and delays revascularization of endosteal blood supply
      • loose fitting nails spare cortical perfusion and allow more rapid reperfusion
      • tight fitting nails compromise cortical perfusion and reperfusion is slow
Flashcards (19)
Cards
1 of 19
Questions (2)

(OBQ12.157) Which of the following arteries provides the blood supply to the outer third of a long bone diaphysis?

QID: 4517

Nutrient artery

14%

(612/4496)

Periosteal arterioles

82%

(3707/4496)

Medullary artery

1%

(54/4496)

Emissary artery

1%

(31/4496)

Perichondral artery of LaCroix

1%

(67/4496)

L 1 B

Select Answer to see Preferred Response

(OBQ05.107) Disruption of which of the following interrupts the major source of nutrients to the growth plate?

QID: 993

Diaphyseal artery

2%

(34/1494)

Metaphyseal artery

31%

(462/1494)

Perichondrial artery

65%

(970/1494)

Synovial fluid

1%

(18/1494)

Synovial blood vessels

0%

(5/1494)

L 1 D

Select Answer to see Preferred Response

Evidence (1)
VIDEOS & PODCASTS (2)
EXPERT COMMENTS (3)
Private Note