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Bone Circulation:

- Discussion:
    - epiphyseal artery
    - metaphyseal artery
    - nutrient artery
    - periosteal vessels
    - see tibia bone circulation

- Pediatric Bone Circulation:
    - circulation in pediatric bone:
          - differs from adult circulation due to requirements of growth & presence of epiphyseal plate;
    - terminal branches of nutrient artery, along w/ metaphyseal vessels, approach growth plate in a parallel relationship;
    - branches are so numerous as they reach growth plate that there is almost one vessel for each column of cartilage cells;
           - in final few mm before terminal arteriole reaches cartilage, it is encased in a tube of enchondral bone;
           - as vessel extends to end of cartilage column, it makes abrupt 180 deg turn to enter larger venule;
           - slowing of the circulation may permit lodging & proliferation of bacteria to produce focus of hematogenous osteomyelitis;
    - function of metaphyseal blood supply (metaphyseal side of growth plate) is to provide nutrition for active cells involved in enchondral ossification;
    - epiphyseal vessels are essential for they supply dividing cells of growth plate & hence are responsible for maintaining longitudinal bone growth

The acute effects of periosteal stripping and medullary reaming on regional bone blood flow.