The blood supply of long bones comes from four systems: nutrient artery, metaphyseal, epiphyseal, and periosteal. The nutrient artery enters through the diaphysis and supplies the inner two-thirds of the cortex and medullary cavity. The periosteal system sends branches through the cortex. The epiphyseal system permits growth through openings into the ossification centers. The metaphyseal system reinforces the nutrient artery and anastomoses with epiphyseal vessels after growth stops. The growth plate itself is avascular and receives nutrients from epiphyseal and metaphyseal arteries. Venous drainage occurs through veins in the medullary cavity,

1. BLOOD SUPPLY OF LONG
BONE

2. SOURCES OF BLOOD
SUPPLY
• Nutrient Artery System
• Metaphyseal System
• Epiphyseal System
• Periosteal System

3. NUTRIENT ARTERY
• Enter through an oblique canal situated on the diaphysis of
long bones aka nutrient foramen.
• It supplies inner 2/3rd of cortex, medullary cavity and
metaphysis.

6. PERIOSTEAL ARTERIAL SYSTEM
• Periosteal vessels send small branches through Volkmann's
canal in cortex to supply about outer 1/3rd of cortex.
• Children, while periosteum is actively engaged in
circumferential bone growth, blood supply in this area is much
more abundant than it is in adult.

8. EPIPHYSEAL ARTERIAL SYSTEM
• The epiphysis has openings that permit passage of large
number of vessels into and out of the ossification centres.
• Epiphyseal vessels are responsible for permitting longitudinal
growth to occur.

10. METAPHYSEAL ARTERIAL SYSTEM
• These arteries directly go into the metaphysis and
reinforce/anastomose with the metaphyseal branches of the
primary nutrient artery.
• Following the growth arrest of the cartilage plate, there is an
extensive anastomoses between epiphyseal vessels,
metaphyseal vessels, & terminal branches of Nutrient Artery.

11. GROWTH PLATE ITSELF IS AVASCULAR &
RECEIVES NUTRITION FROM 2 SOURCES.
EPIPHYSEAL ARTERIES
• Epiphyseal vessels that
supply resting, germinal,
proliferating, and upper
hypertrophic cell layers by
diffusion
METAPHYSEAL ARTERIES
• Metaphyseal vessels that
supply zone of provisional
calcification.

12. REF : UPTODATE

13. PEDIATRIC BLOOD FLOW
• In young child, epiphyseal vessels are separated from
metaphyseal vessels.
• Circulation in pediatric bone differs from adult circulation due
to requirements of growth & presence of epiphyseal plate.
• Terminal branches of nutrient artery, along with metaphyseal
vessels, approach growth plate in a parallel relationship.

15. VENOUS DRAINAGE
• Long bones posses a large venous sinus.
• Long bones drains into central venous sinus ,from Central venous
sinus through nutrient vein, periosteal veins and emissery veins it
drains out.
• Metaphyseal/epiphyseal veins – drain blood from the proximal and
distal regions of the medullary cavity.
• Periosteal veins – drain blood from the ends of long bones and the
red bone marrow.
• ONLY 5-10% OF VENOUS DRINAGE IS THROUGH NUTRIENT VEIN;
REMAINING IS THROUGH PERIOSTEAL VENOUS DRINAGE

16. REF : ORTHOBULLETS

17. OSTEOMYELITIS
• Hair pin arrangement of
metaphyseal arterioles
• Circulating organisms tend to
start the infection in the
metaphyseal ends of the long
bones because of the sluggish
circulation in the metaphyseal
capillary loops.
• More common in infants and
children.

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