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Year |
2001 |
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Question Number |
124. |
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Category |
Select |
Question
Where does the nutrient artery to the tibia most commonly enter the bone?
1- Anteriorly above the pes anserinus
2- Anteriorly 4cm above the ankle
3- Laterally above the fibular head
4- Posteriorly below the posterior cruciate ligament insertion
5- Posteriorly in the medial malleolus
Figures
Answer (click for answer)
Preferred Answer: 4
The nutrient artery enters the tibia posteriorly below the PCL insertion. The referenced article does not discuss the course of the artery.
The article quantified the changes in nutrient artery blood flow following reamed and unreamed nailing of intact canine tibias. Eighteen dogs underwent nutrient artery blood flow measurements through implantable ultrasonic blood flow probes placed around the nutrient artery of the tibia over a fourteen-day period. The intervention groups consisted of controls (Group I), nailing without reaming (Group II), and nailing with reaming (Group III). Nutrient artery blood flow averaged 1.94 milliliters per minute over the fourteen-day period in Group I (no reaming or nailing performed). Nutrient artery blood flow following nailing without reaming (Group II) decreased to 44 percent of baseline values immediately after the procedure. By postoperative day 1, flow had decreased to 23 percent of baseline; over the fourteen-day period, nutrient artery blood flow recovered toward baseline values. Immediately following nailing with reaming (Group III), nutrient artery blood flow measured zero milliliters per minute. Over the fourteen-day period, nutrient artery blood flow in this group averaged 39 percent of the baseline level (range 19 to 58 percent). Whereas nutrient artery blood flow recovered toward baseline values (99 percent of baseline) by fourteen days in Group II, nutrient artery blood flow measured only 26 percent of the baseline level on postoperative day fourteen in Group III. The data suggest that nailing with reaming provides a double insult to the nutrient artery distribution.
Reference: Brinker MR, Cook SD, Dunlap JN, Christakis P, Elliot MN: Early changes in nutrient artery blood flow following tibial nailing with and without reaming: A preliminary study. J Orthop Trauma 1999:13:129-133.