The Periosteal Contribution to Diaphyseal Blood Supply

Abstract

Precise knowledge of the important portals of entry of blood to the fracture site is vital to our understanding of delayed union. There are four possible routes, namely: extraosseous, periosteal, intracortical and medullary, but the relative importance of each is not known with any certainty. Despite more than a century of debate, the exact periosteal contribution to the blood supply of the diaphyseal cortex during fracture repair is still unclear. Some workers, notably Rhinelander (1974), believe that the medullary circulation was the most important. By contrast, others, notably Brookes (1971), emphasize the importance of the periosteal circulation as a collateral blood route during fracture repair.