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BLOOD SUPPLY OF LONG
BONE
SOURCES OF BLOOD
SUPPLY
• Nutrient Artery System
• Metaphyseal System
• Epiphyseal System
• Periosteal System
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.
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.
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.
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.
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.
REF : UPTODATE
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.
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
REF : ORTHOBULLETS
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.
THANK YOU :)

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Blood Supply of Long Bone and Osteomyelitis by Aakash Pandit

  • 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.
  • 4.
  • 5.
  • 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.
  • 7.
  • 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.
  • 9.
  • 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.
  • 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.
  • 14.
  • 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
  • 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.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.