THE
BLOOD
SUPPLY
OF DEVELOPING
WITH
SPECIAL
REFERENCE
TO THE
0.
From
Humphry
the
Sicher
metaphysis,
its
more
periosteum.
nutrient
that
peripheral
Trueta
artery
did
and
out
the
St Thomas’s
blood
Hospital
supply
to
nutrient
the
nutrient
artery
also
being
supplied
by
Harrison
reach
ENGLAND
the
parts
and
not
LONDON,
a dual
bone
pointed
LEWIS,
of Anatomy,
described
compact
(1947)
the
the Department
(1858)
supplying
J.
artery
(1953)
metaphysial
LONG
BONES
METAPHYSES
Medical
any
long
supplying
believed
region,
School
the
bone,
supplied
that
in
was
central
the
adult
and
part
arteries
wholly
vessels
Weinmann
the
metaphysial
which
periosteal
marrow.
of
derived
human
supplied
the
from
femur
the
by metaphysial
arteries.
and
Weinmann
plate,
and
the
invading
opening
tissue.
up of the
The
the
Sicher
the
produced
vessels
and
vessels
of
the
the
of
vessels
blood
nutrient
arteries
in the
metaphyses
progressively
developing
approaching
and
invading
of
an
injected
to
form
in
osteoblasts
the
the
to
epiphysial
applied
centre
of
of supply
and
described
of mesenchymal
the
to
masses
tissue.
extent
bones
(1925)
masses
invading
the
long
FIG.
Metatarsal
said
lumina,
cartilaginous
Stump
ofsyncytial
of
to determine
epiphysial
while
were
formation
was
in
the
loops,
masses
the
investigation
approaching
by the activity
syncytial
with
of this
the
of
vessels
hairpin-shaped
lacunae
cavitation,
extension
purpose
the
as long
cartilage
parts
while
the
The
dilated
peripheral
trabeculae,
described
cartilage,
study
of the
the
cartilage
periosteal
form
of
those
plate.
I
twenty-six
day
rabbit
embryo
showing
nutrient
artery
giving
branches
terminating
in
dilations
at the metaphysis
of either end.
The periosteal
plexus
of blood vessels can be seen on the surface
of the
bone.
(x35.)
METHODS
Long
injected
or
bones
with
teased
foetus
tibia,
Monastral
The
injected
Blue
being
Indian
with
bones
femora,
Fast
preparations
injected
human
(e.g.,
material
stained
with
metatarsals)
BNVS
cleared
ink
was
and
were
of
paste,
were
mounted.
rabbit
embryos
used,
In
the
and
addition,
the
young
rabbits,
bone,
l00,s
sections,
phalanges
of
a human
whole
examined.
correlated
haematoxylin
with
and
histological
eosin,
sections
Heidenhain’s
of
iron
developing
rabbit
haematoxylin,
and
or Azan.
OBSERVATIONS
During
the
metaphysis,
vessels
928
the
is being
early
stages
is supplied
included
of ossification
by
in the
the
nutrient
developing
of a long
artery,
periosteal
bone
while
all
some
bone
THE
the
endochondral
of the
as its blood
JOURNAL
bone,
periosteal
plexus
supply
OF
BONE
(Fig.
AND
JOINT
including
of blood
1).
SURGERY
BLOOD
THE
SUPPLY
As the
periosteal
bone
grows,
vessels,
while
cavity
vessels
containing
approaching
plexus
and
by
the
OF DEVELOPING
LONG
more
the
periosteal
are the metaphysial
periosteal
artery,
vessels
of supply,
SPECIAL
is laid
bone
REFERENCE
down,
and
is progressively
runs
while
the central
through
to enter
the
the
part
(Figs.
of
supplied
by included
to form
a medullary
peripheral
from
the
the
929
METAPHYSES
of the metaphysis
bone
cavity
b
a
is also
The more
now derived
compact
medullary
TO THE
removed
by the nutrient
artery.
cartilaginous
plate
are
arteries,
which
WITH
bone
endochondral
marrow
supplied
the epiphysial
nutrient
BONES
of those
periosteal
is still
supplied
shaft
parallel
the
nutrient
to
its
2 to 5).
a
2
FIG.
An early stage in the development
of a
long bone, with a later stage superimposed.
Growth of the bone leads to
deposition
of periosteal
bone, a, with
its obliquely
running
periosteal
vessels,
on the surface
of the endochondral
bone, b, the peripheral
parts of the
metaphysis
come to be supplied
by
metaphysial
arteries
derived from the
periosteum.
The
vessels
approaching
or the metaphysial
its dilated
lacunae.
related
to the
epiphysial
sections
Histological
the
arteries,
Groups
Epiphysial
epiphysial
The
that
the
opened
is, on
all
pattern
sides
diaphysis.
No vessels
epiphysis,
up in the
vascular
same
of
were
at any
the
seen
whether
cartilage
centre
traversing
derived
from
where
they meet
the
end in a saccular
dilation
vessels
at the advancing
secondary
c.
approach
the
artery
plate,
with
intimately
epiphysial
plate
which
open
into the dilated
cartilage
lacunae
which
the fine vessels
approaching
the epiphysial
plate
in
and have a peripheral
mesenchymal
sheath
of cells
saccular
endings
are the blood-filled
lacunae,
unlined
degenerating
is seen
plate,
terminations
fine vessels
6 to 8).
endothelial-walled
and terminate
by funnel-shaped
endings
thus become
filled with blood.
Thus,
injected
specimens
are endothelial-walled,
developing
into osteoblasts,
while their
by endothelium,
plate,
have
specialised
of two or three
plate (Figs.
show that
cartilage
the
of
(Figs.
margin
ossification
epiphysial
9 to
11).
of ossification
in the epiphysis-
except
surface
at the
cartilaginous
plate,
from
related
to
diaphysis
to
stage.
DISCUSSION
The
running
periosteal
VOL.
38 B,
compact
an
periosteal
oblique
plexus
NO.
4,
and
of blood
NOVEMBER
bone
parallel
vessels,
1956
of the
course
while
shaft
of a developing
through
the
the
endochondral
long
compact
bone,
bone
is supplied
bone
and
derived
until
its removal,
by vessels
from
is supplied
the
930
0.
J. LEWIS
I:
0
1.
I
FIG.
3
Figure 3-Injected
tibia of a
entering
bone parallel
to the
compact
periosteal
bone of
injected
tibia of a thirty-seven
part of the metaphysis
FIG.
thirty-seven
day old rabbit
obliquely
running
periosteal
the shaft.
(x 30.)
Figure
day old rabbit.
The blood
from periosteal
vessels can
FIG.
Same
bone
as Figure
entering
from
4, showing
the
4
showing
nutrient
artery
vessels supplying
the
4-Upper
extremity
of
supply of the peripheral
be seen.
(x 3.)
5
a metaphysial
periosteum.
(x
THE
artery,
a,
35.)
JOURNAL
OF
BONE
AND
JOINT
SURGERY
THE
by
the
the
as
SUPPLY
BLOOD
OF DEVELOPING
nutrient
the
In
artery.
medullary
cavity.
bone
the
The
grows
supply
of the
and Harrison
LONG
later
BONES
stages
metaphysis
metaphysial
WITH
the
is at
arteries
region
in the
adult
femur
preparation
day
saccular
dilations
supplies
by
from
TO THE
the
the
the
bone
nutrient
periosteum
take
cells
itself
fill
the
columns
lined
by
a layer
formed,
thus
so
The
VOL.
the
end
38 B,
dilated
of
dilated
of
no
cartilage
endothelial
metaphysis
tibia
showing
on the vessels
eroding
plate.
(x
progressively
of
endothelial
periphery
of each
of
the
NO.
growth
4,
NOVEMBER
lacunae
contact
cells.
cells
In
specimens
layer
is observed
vascular
1956
the
the
up
at
Trueta
to the
of
a
the
the epiphysial
the
line
of
the
inner
the
as
and
this
play
the
in
the
of
cartilage
invasion
their
cartilaginous
walls.
by
Trueta
and
and
of
osteoblasts
tubules
new-formed
are
the
in eroding
cartilaginous
line
advances
to
35.)
a part
a layer
of
vessels
related
(x
ossification
may
process
walls
of ossification
described
of advancing
cartilage
wake
lining
centre
loops,
blood
Thus,
blood
110.)
endothelial-walled
injected
secondary
at
with
extends
forming
the
but
6
injected
embryo
rabbit
cartilage
in direct
dilations
and
The
at
of
saccular
lacunae
the
is apparently
of
only,
over
FIG.
7
FIG.
8
Figure
7-Showing
the line of saccular
dilations
on the vessels where they are
the epiphysial
cartilage
plate.
Injected
tibia of twenty-six
day rabbit
embryo.
Figure
8-Another
IOOjs section
of same bone as in Figure 7. (x 100.)
Blood
marrow
artery
2).
cartilage
blood
931
METAPHYSES
to an ever-increasing
extent.
the nutrient
artery
supplied
any
FIG.
Teased
twenty-six
artery
supplied
derived
(Fig.
REFERENCE
nutrient
first
peripheral
parts
of the metaphysis
(1953)
found
no evidence
that
metaphysial
SPECIAL
bone.
blood-filled
in similar
fashion
and
Harrison,
beneath
the
932
0.
J. LEWIS
adult
articular
vessels
the
their
Since
the
produce
were
the
explained.
Section
of
twenty-six
metaphysis
day
rabbit
of
tibia
embryo
of
settle
a
from
by vessels
the
supply
derived
periosteum
take
progressively
from
the
completion
of
to
which,
for infection.
hairpin-like
form
and
be sluggish
and
in this
as
has
the
been
sug-
vessels
described,
the
be less
readily
terminations
saccular,
blood
emboli
fragile
readily
Ifthe
would
as
dilated
of
would
usually
haematomata
of advancing
walls
region
haematomata
Alternatively,
are
the
line
by
of
flow
might,
therefore,
in
the
them
easily
situation.
showing
SUMMARY
blood-filled
lacunae,
a, corresponding
to
the saccular
dilations
shown
in Figures
6, 7 and 8. Stained
with Heidenhain’s
iron haematoxylin,
8js section.
(x 80.)
is supplied
only
act as a nidus
ofsuch
vessels
derived
by
at the
metaphysis
trauma
small
of
would
is confined
the
might
occurrence
9
blood
cartilage,
gested,
perhaps
dilations
walls.
of
calcified
are
saccular
endothelial
ossification
FIG.
cartilage,
and
only
over
1
from
the
Periosteal
.
and
bone
endochondral
2.
In the
the
nutrient
supply
earliest
of its
is
supplied
bone
stages
artery.
periosteal
nutrient
the
metaphysial
part,
the
vessels
artery.
of development
Later,
peripheral
by
by the
extent
metaphysis
arteries
derived
of their
area
of
increasing.
4’
I
FIG.
10
FIG.
11
Figure
10-Section
of metaphysis
of a twenty-five
day rabbit embryo
tibia.
Blood cells are seen lying free
in the lacunae
without
the intervention
of an endothelial
wall. e, endothelial
cell. 8 section.
Heidenhain’s
iron haematoxylin.
(x 330.)
Figure
lI-The
same bone as in Figure
10, again showing
the unlined
bloodfilled lacunae
at the termination
of a vessel which opens in funnel-like
fashion
into the lacuna.
e, endothelial
cell. (x 500.)
3.
In
end
in saccular
lacunae,
epiphysial
injected
with
specimens
dilations.
no
endothelial
the
blood
vessels
Histological
lining
and
approaching
the
sections
show
these
into
which
open
epiphysial
dilations
the
blood
cartilaginous
to be blood-filled
vessels
plate
cartilage
approaching
the
plate.
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
THE
BLOOD
I would
like
assistance
SUPPLY
OF DEVELOPING
to
Professor
and
thank
D.
Mr J. S. Fenton
and
LONG
V. Davies
BONES
for
WITH
valuable
Mr A. L. Wooding
SPECIAL
advice
and
REFERENCE
criticism,
TO THE
Mr
G.
METAPHYSES
Maxwell
for
933
technical
for the photographs.
REFERENCES
HARRIS,
HARRIS,
The Vascular
H. A. (1929):
of Anatomy,
H.
Supply
ofBone,
with Special
Reference
to the Epiphysial
Cartilage.
Journal
64, 3.
A.
(1933):
Bone
Growth
in Health
and Disease.
London:
Humphrey
Milford,
Oxford
University
Press.
HUMPHRY,
G.
M.
A. (1919):
KEITH,
(1858):
Studies
A
Treatise
on the
Human
on the Human
Anatomical
Skeleton.
Changes
which
Cambridge:
Accompany
Macmillan
Certain
and Co.
Growth-disorders
of the
Body. Journal of Anatomy,
54, 101.
PAYTON,
C. G. (1934):
The Position
of the Nutrient
Foramen
and Direction
of the Nutrient
Canal
in the
Long Bones of the Madder-fed
Pig. Journal of Anatomy,
68, 500.
STUMP,
C. W. (1925): The Histogenesis
of Bone.
Journal
of Anatomy,
59, 136.
TRUETA,
J., and HARRISON,
M. H. M. (1953):
The Normal Vascular Anatomy
of the Femoral Head in Adult
Man. Journal of Bone and Joint Surgery, 35-B, 442.
WEINMANN,
J. P., and SICHER, H. (1947): Bone and Bones.
Fundamentals
of Bone Biology.
London:
Henry
Kimpton.
VOL.
38
B,
NO.
4,
NOVEMBER
1956