Features of Shin Blood Supply in Ankle Joint

Morphological studies of blood supply peculiarities in human limbs, and the elucidation of the variant anatomy of the nutritional arteries are acute tasks for anatomy scientists, orthopedics and traumatologists. The need to preserve arterial vessels during surgical fixation of fractures, providing adequate blood supply to the limbs can be the determining factor in choosing correct method of osteosynthesis. Investigation of the topography of arteries in this region of the lower limb will allow choosing a well-known or developing a new optimal method of immobilization of fractures, to avoid postoperative complications and to improve the effectiveness of treatment. The purpose of the study was to investigate the topography of penetrating arteries in the lower third of the shin during human ontogenesis. Materials and methods. The research was conducted on 25 human prefetuses and fetuses' preparations, aged from 3 to 9 months of prenatal development; 26 bone preparations of lower extremities of adults and 24 series of computer tomograms in adults aged 23-72. We used a complex of morphological research methods: anthropometry, morphometry, injection of blood vessels by X-ray contrasting macromicroscopy mixtures, three-dimensional reconstruction and statistical analysis. Results and discussion. Cartilage osteogenesis occurs in the prefetal period of prenatal human development, where blood vessels play a crucial morphofunctional role. During endochondral ossification of the tibia, there occurs the germination of vessels of the bone cuff inside the diaphysis of the cartilaginous bone model and exit of osteogenic cells beyond their limits. In the third trimester of prenatal development, blood vessels grow into the epiphyseal part of the cartilaginous model, and an epiphyseal center of ossification is formed. A metaphysical growth plate is formed between the epiphysis and diaphysis centers of ossification. A metaphysical growth plate develops intraosseous anastomosis between the diaphyseal and metaphysical blood vessels. In the metaphysis area, there is extra-skeletal anastomosis. The insertion of arteries into the bone of tibia is usually the middle third of bones (54%) and distal metaphysis (36%). There were nourishing holes in the upper third of the tibia in 10%. Three-dimensional reconstruction also clearly shows a more branched and developed mesh of vessels in the bone marrow in metaphysical regions. There can be traced 1-3 nutrient holes in the middle third of the large and small-shin bones in most preparations. In addition to the back-medial localization of the nutritional arteries, there were variants with a "high" (above the metaphysis) placement of entrance of vessel into the bone matter on the fibular. Conclusions. Most common insertion of arteries into the bone of the tibia was usually the middle third of the bone (in 54%) and distal metaphysis (in 36%). In 10% there were nourishing holes in the upper third of the tibia. The three-dimensional reconstruction also clearly showed a more branched and developed mesh of vessels in the bone marrow in metaphysical regions. During postnatal period, we most often encountered the localization of nutritional arteries on the anterior-lateral surface of the tibia (23%), or their combination – the presence of both nutrient arteries on the posterior and medial bone surfaces (18.3%).