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Nutrient Artery

- See:
      - Epiphyseal Artery
      - Metaphyseal Artery
      - Periosteal Artery

- Discussion:
     - nutrient artery enters into the diaphysis of long bones through an oblique canal;
     - direction of canal is determined by relative amount of growth that has occurred at proximal and distal ends of the bone;
           - nutrient canals slope away from the knee in femur, tibia, and fibula and towards elbow in radius, ulna, and humerus;
     - does not branch within the cortex.
     - nutrient artery divides after reaching the medullary cavity, sending arteriole branches in proximal and distal directions and join w/ metaphyseal arteries
     - vessels radiate from these medullary arteries to the cortex, and drain to venules on the periosteal surface of the bone;
     - direction of blood flow is from endosteum to periosteum;
     - intramedullary pressure is higher than periosteal surface allowing of egress of intersitial fluid in cortex;
     - some of these branches enter cortex to supply haversian canals of inner two thirds of the cortex;
           - other branches of nutrient artery continue in more or less parallel alignment to metaphysis;
           - in the child, these vessels end on metaphyseal side of epiphyseal plate, where they participate in enchondral ossification;

- Disruption of Nutrient Artery:
     - in growing bone can result in necrosis of large portion of marrow & of inner two thirds of cortex;
            - this cortical death does not occur in adult bone because combined epiphyseal-metaphyseal collateral circulation is developed enough to maintain these areas;
             - loss of circulation in terminal vessels of nutrient artery of growing bone will interfere w/ enchondral ossification

Early changes in nutrient artery blood flow following tibial nailing with and without reaming: a preliminary study.