Topographic and morphometric features of the nutrient foramina of the fibula in the South African mixed-ancestry population group and their surgical relevance

Nutrient foramina are canals that convey nutrient arteries and nerves into the diaphysis of long bones to supply the medullary cavity. The aim of the present study was to investigate the direction, number, location and position of nutrient foramina on the shafts of the fibulae. 201 dry fibulae of adult 20th-century mixed-ancestry South Africans were macroscopically examined for direction, number, location and position of the nutrient foramina. For each bone, a Foraminal Index was calculated giving the position of the nutrient foramina in relation to the bone length. Most of the fibulae (87.1%) had their nutrient foramina directed towards the ankle joint, while few (5.5%) had their nutrient foramina directed towards the knee joint. A single nutrient foramen (90.0%) was most frequent, and also the posterior surfaces of the shafts of the fibulae harbored the majority (50.6%) of the nutrient foramina. A rare location of the nutrient foramina was identified on the interosseous borders (22.2%) of the fibulae in this population. Nutrient foramina were positioned mainly on the middle third (1/3) of the shafts of the fibulae with the Foraminal Index ranging between 33.02-75.57% and a mean of 42.46±14.42%. In conclusion, the middle segment of the shafts of the fibulae of the mixed-ancestry South African population was the most common site for nutrient foramina, and thus makes it ideal for harvesting long portions of free vascularised cortical bone grafts for treatment of massive bone loss and fractures

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Bone and wound healing in the diabetic patient.

Impaired soft tissue regeneration and delayed osseous healing are known complications associated with diabetes mellitus with regard to orthopedic surgery, making the management and treatment of diabetic patients undergoing foot and ankle surgery more complex and difficult. At the moment several options are available to address the known issues that complicate the clinical outcomes in these high-risk patients. Using a multifaceted approach, with close attention to intraoperative and perioperative considerations including modification of surgical technique to supplement fixation, local application of orthobiologics, tight glycemic control, administration of supplementary oxygen, and biophysical stimulation via low-intensity pulsed ultrasound and electrical bone stimulation, the impediments associated with diabetic healing can potentially be overcome, to yield improved clinical results for diabetic patients after acute or elective foot and ankle surgery.