Endosteal Vasculature Dominates Along the Tibial Cortical Diaphysis: A Quantitative Magnetic Resonance Imaging Analysis
| Autor: | Jonathan P. Dyke, Naomi E. Gadinsky, Ashley E. Levack, David L. Helfet, Craig E. Klinger, Maggie Fung, Dean G. Lorich |
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| Rok vydání: | 2020 |
| Předmět: |
Quantitative magnetic resonance imaging
Bone healing Article Bone and Bones 03 medical and health sciences 0302 clinical medicine Cortex (anatomy) medicine Humans Orthopedics and Sports Medicine 030222 orthopedics Tibia medicine.diagnostic_test business.industry Nutrient artery 030208 emergency & critical care medicine Magnetic resonance imaging General Medicine Anatomy Tibial Fractures Diaphysis medicine.anatomical_structure Surgery Diaphyses Cadaveric spasm business Perfusion |
| Zdroj: | J Orthop Trauma |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0000000000001853 |
| Popis: | OBJECTIVE Disrupted blood supply has been proposed as an underlying cause for delayed union in tibial shaft fractures (OTA/AO 42). Although tibial blood supply has been qualitatively evaluated, quantitative studies are lacking. The purpose of this project was to quantify the relative contribution of the endosteal supply to the tibial diaphysis. METHODS The superficial femoral artery of 8 fresh frozen cadaveric matched pair lower extremities was cannulated. The nutrient artery was ligated at its proximal branch point in experimental limbs. Pregadolinium and postgadolinium enhanced magnetic resonance imaging was performed with high resolution fat-suppressed ultrashort echo time magnetic resonance imaging sequences. Perfusion was assessed in 3 zones (outer, central, and inner cortex) for the proximal, middle, and distal diaphysis, respectively, using custom software to quantify and compare signal intensity between experimental and control limbs. RESULTS On average, the endosteal system supplied 91.4% (±3.9%) of the cortex and was the predominant blood supply for the inner, central, and outer thirds. The dominance of the endosteal contribution was most pronounced in the inner two-third of the cortex, with more than 97% loss of perfusion. Disruption of the nutrient artery also resulted in 76.3% (±11.2%) loss of perfusion of the outer one-third of the cortex. CONCLUSION This quantitative study revealed a predominance of endosteal blood supply to all areas (inner, middle, and outer thirds) of the tibial diaphyseal cortex. To prevent delayed bone healing, surgeons should take care to preserve the remaining periosteal vascular network in fracture patterns in which the nutrient artery has likely been disrupted. |
| Databáze: | OpenAIRE |
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