GENERAL ANATOMY OF

BONES II
By DR Hira waqas Cheema
Assistant professor
Anatomy
 Learning objectives
• Describe arterial supply of long,short,flat and irregular
bones
• Explain venous drainage of long bones
• Explain the process of healing of a fracture.
Types of bones
Anatomy of a long bone

Copyright 2009 John Wiley & Sons, Inc.

 Bone tissue cell
types
• Osteogenic cells – unspecialized stem cells

• Osteoblasts – bone builders

• Osteocytes – mature bone cells derived from

osteoblasts

• Osteoclasts – bone ‘breakers’ are multinucleate

 Blood supply to long bone

comes from three sources

– Nutrient artery system

– Metaphyseal and epiphyseal system

– Periosteal system
Copyright 2009 John Wiley & Sons, Inc.
 Nutrient foramen
• Oblique canal situated in the
diaphysis of long bones.

• Nutrient canals slope away from

the knee for femur tibia and fibula.

• Canal facing towards elbow in

radius, ulna, and humerus

• 90% of long bones have single

nutrient foramen in middle third of
the shaft
 Nutrient artery system
• All long bones have one or
more nutrient arterites
that enter through a
nutrient foramen

• High pressure system that

branches from
major systemic arteries

• Enter the cortex through the

nutrient foramen and enter
the medullary canal
Nutrient artery

– Then branches into ascending and

descending branches

– Each branch sends lateral oriented

arteriolar branches

– Ascending and descending branches travels

to the end of the bone they anastomosis with
metaphyseal and epiphyseal vessels
• With in the cortex they give rise
to branches , Some extending
longitudinally along the axis of
long bone while others proceed
radially and ultimately forms
capillaries with in the haversion
system .

• Some arterioles transfers the

entire cortex to reach and
anastomose with periosteal
arteriolar network.
• With in the marrow , Some
arterioles are short and
profusely branched to supply
the capillaries for the
marrow .

• This system supplies the inner 2/3 of

via the haversion system.
 Metaphyseal system
• Derived from the neighboring
systemic vessels.

• These arteries directly go into

the metaphyses and reinforce
the metaphyseal branches of
the primary nutrient artery.
 Epiphyseal arteries
• The epiphysis has openings that
permit passage of large number
of vessels into and out of the
ossification centers.

• Growth plate itself is avascular &

receives nutrition from 2 sources.

.
• In young child, epiphyseal vessels are
separated from metaphyseal vessels.

• Following growth arrest of the

cartilage plate, there is an
anastomoses between epiphyseal
vessels, metaphyseal vessels, &
terminal branches of nutrient artery.

• Obliteration of epiphyseal blood

supply results in necrosis of epiphysis
& deprives deeper cartilage cells of
growth plate for their nutrition.
• Longitudinal growth ceases &collateral
circulation is not quickly restored,
permanent closure of epiphyseal plate
occurs.

• Epiphyseal vessels are responsible for

permitting longitudinal growth to occur.

• Metaphyseal vessels
nourish osteoprogenitor cells , which lay
down bone on cartilage matrix.
 Anatomy of periosteum
• Periosteum consists of two
layers outer fibrous and
inner cambium layer.

• The fibrous layer contains

fibroblasts

• The cambium layer

contains progenitor cells
that develop into
osteoblasts.
 Periosteal System
• Low pressure system that
supplies the outer 1/3 of bone

• Forms an extensive network of

vessels covers entire length of
the bone shaft.

• Periosteal vessels send small

branches through minute
channels in cortex to supply
about outer 1/ of cortex.
• Periosteal arteries are the arteries
of periosteum being especially
numerous beneath the muscular
and ligamentous attachment.

• Beneath the periosteum they

divide into branches and thereby
entering the Volkmann’s canals to
supply the outer one third (1/3)
portion of the cortex.
Paediatric Blood supply
• 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.

• 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

• Children, while periosteum is

actively engaged in circumferential
bone growth, blood supply in this
area is much more abundant than it
is in adult
 Venous drainage of bone
• 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.
Venous drainage of bone
• 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
 Blood Flow through the bone
• There are two theories behind
this
Centrifugal flow and
centripetal flow

Centrifugal flow
• With the blood entering the
endosteal aspect from the
medullary nutrient system and
flowing through the periosteal
surface
.
Centripetal flow

• The medullary nutrient system is

interpted ,the periosteal system
provides a reverse supply and blood
flow becomes centripetal (Towards the
center)
Blood supply of head and neck of femur
Blood supply of short
bones
Numerous fine periosteal blood vessels from periosteum
enter through non articular surfaces

Venous supply
Venous drainage occur through two veins which leave
through vascular foramina in non articular surfaces
Flat bones
Flat bone sof skull receives
vessels from periosteal
plexus.The veins are thin
walled and tortuous in
diploe.

Ribs receives both

• periosteal arteries
• Nutrient artery close to
tubercle
 Irregular bones
They receive blood from two systems(scapulae,hip bone
Periosteal
Nutrient artery
The branches of both systems anastomose with each
other
Blood supply of
vertebae

They receive two arteries

close to base of each
transverse process
The spongy bone is drained
via two veins called
basivertebral veins which
converge to a foramen on
posterior surface of vertebral
body
 Fracture
A break in continuity of bone
Two types
Open fracture with open skin wound
Closed fracture
Without open skin wound
Healing of fracture

Granulation Fibrocartilage Bony callus

tissue callus
Granulation tissue

Damaged blood vessesls form blood clot

Capillaries,fibroblasts and osteoprogenitor cells invade to
form loose connective tissue called granulation tissue
 Fibrocartilage callus
Osteoprogenator cells transform into chondroblast cells of
hyaline cartilage
This mass of CT and cartilage is called fibrocartilage callus.
Bony callus
Chondroblast cells differentiate into osteoblast and thus
fibrocartilage callus is replaced by bony callus.

The bony callus is then replace by mature bone.Excess

bone formed is resorbed.
THANK
YOU