Blood Supply of Bone, Bone Formation and Histology of the Physis–Epiphysis Complex
DNB Orthopaedics • October 2024 • Paper I • 10 Marks
Introduction
Bone is a highly vascular living tissue. Its blood supply is essential for growth, remodelling, fracture healing, maintenance of osteocytes and resistance to infection.
The vascular anatomy of a long bone differs considerably between the growing child and the adult, particularly because the physis acts as an important vascular barrier during skeletal growth.
Core concept
Adult long bone has communication between epiphyseal and metaphyseal circulation after physeal closure, whereas in the growing child the physis largely separates these vascular territories.
Blood Supply of a Long Bone
A typical long bone receives blood from four principal vascular systems:
1. Nutrient artery
Main arterial supply to the medullary cavity and inner cortical bone.
2. Metaphyseal arteries
Arise from periarticular vascular anastomoses and supply metaphyseal bone.
3. Epiphyseal arteries
Supply epiphysis and subchondral bone through periarticular vessels.
4. Periosteal vessels
Supply the outer cortex and become particularly important following fracture or disruption of the nutrient circulation.
1. Nutrient Arterial System
The nutrient artery is usually the dominant blood supply to the shaft of a long bone.
- Enters…