Vascular anatomy of the radius and ulna diaphyses in their reconstructive surgery

The vascular factor in the unsuccessful healing of the osteotomised forearm bone is widely discussed in literature at the so-called "level operations" aiming at correcting the "ulna minus" variant in Kienböck's disease. The purpose of our study was to trace the nourishing vessels of the forearm bones from their source from which a. nutritia radii (ANR) and a. nutritia ulnae (ANU) is separated and to locate the foramen nutritium (FN) of the radial and ulnar bones diaphysis. The forearms of 70 upper extremities were dissected and 204 macerated radial bones and 134 macerated ulnar bones were investigated scopically and metrically. The results demonstrated that there is less variability of sources from which ANR was separated as compared to the variability of the sources from which ANU was separated. Foramen nutritium radii (FNR) and foramen nutritium ulnae (FNU) were located mainly along facies anterior and its edges margo anterior and margo interosseus and only in a few cases they were observed along facies posterior. The metrical investigations showed that FNR were located mainly in the second fourth along the bone length, between 30 and 40% from the radial bone length in the distal direction. FNU were located mainly in the second fourth along the bone length, between 30 and 50% from the ulnar bone length in the distal direction. The results for vascular anatomy of the forearm bones give grounds to assume that osteotomy with a subsequent shortening of the radius is more feasible than osteotomy with ulnar lengthening. The distal half of the radius, between the third and fourth quarter in particular, is also recommended as most suitable for surgical intervention.