A comprehensive CT analysis of tibial nutrient artery anatomy: identifying critical areas to avoid in orthopedic procedures

Abstract

PurposeThis study aims to examine the location, number, course, and diameter of tibial nutrient canals in detail to minimize potential vascular damage during orthopedic interventions such as fracture fixation and bone graft procedures.MethodsA total of 56 dry tibiae were scanned via CT with a slice thickness of 0.75 mm. The number, length, diameter, and location of the nutrient canals relative to the tibial plateau were recorded. Pearson correlation and Mann-Whitney U tests were conducted to evaluate the relationships between the measured canal parameters and tibial metrics.ResultsFifty-eight nutrient canals were identified. Among these, 98.27% were located within the distal portion of the proximal third or the proximal portion of the middle third of the tibia. The nutrient canals were predominantly concentrated (81.03%) in the posterolateral region, with the remainder distributed among the posterior, posteromedial, and anterolateral surfaces. The findings indicated that the region with a high likelihood of encountering a nutrient canal extends from approximately 6.96 cm to 22.75 cm along the tibial shaft, spanning a 135 degrees-225 degrees arc.ConclusionA detailed anatomical understanding of tibial nutrient arteries is essential for preserving blood flow and preventing iatrogenic vascular injuries in orthopedic procedures, particularly during internal fixation and graft applications. Identifying this region with high nutrient canal density may help reduce nutrient artery injury and promote faster fracture healing.