This 2006 narrative review by McCarthy summarizes the physiology of bone blood flow — vascular anatomy, measurement techniques, transcapillary and extravascular transport, vascular reactivity, and the circulatory basis of fracture repair, osteonecrosis, and osteoporosis — addressing why standard circulatory research methods are difficult to apply to bone.
When planning fracture fixation — especially intramedullary nailing with reaming or periosteal-stripping plating — remember that each technique selectively compromises a different vascular pathway: reaming impairs medullary flow while the periosteum compensates sixfold, but stripping the periosteum without that compensation leads to nonunion.
In patients with risk factors for impaired bone circulation (corticosteroids, smoking, alcohol, sickle cell, coagulopathies, or advanced atherosclerosis), anticipate both higher osteonecrosis risk and slower fracture repair due to the combined hypersensitivity to vasoconstrictors and reduced vasodilatory reserve in bone vasculature.
This 2006 narrative review by McCarthy summarizes the physiology of bone blood flow — vascular anatomy, measurement techniques, transcapillary and extravascular transport, vascular reactivity, and the circulatory basis of fracture repair, osteonecrosis, and osteoporosis — addressing why standard circulatory research methods are difficult to apply to bone.
When planning fracture fixation — especially intramedullary nailing with reaming or periosteal-stripping plating — remember that each technique selectively compromises a different vascular pathway: reaming impairs medullary flow while the periosteum compensates sixfold, but stripping the periosteum without that compensation leads to nonunion.
In patients with risk factors for impaired bone circulation (corticosteroids, smoking, alcohol, sickle cell, coagulopathies, or advanced atherosclerosis), anticipate both higher osteonecrosis risk and slower fracture repair due to the combined hypersensitivity to vasoconstrictors and reduced vasodilatory reserve in bone vasculature.