Tibial Nutrient Artery

arteria nutricia tibiae

The tibial nutrient artery is a branch of the posterior tibial artery, entering the posterior tibial cortex through the nutrient foramen in the upper third of the tibial shaft. It is the largest nutrient artery in the body, reflecting the massive cortical bone mass of the tibia. Distally it anastomoses with periosteal vessels from the anterior tibial artery.

Region: Lower Leg

Clinical Relevance

Clinical Notes

The tibial nutrient artery is at risk during posterior tibial approaches and tibial reaming for intramedullary nailing, where the reamer disrupts the endosteal blood supply. Following tibial reaming, cortical vascularity relies predominantly on periosteal vessels, so periosteal stripping should be minimised. In open tibial fractures with extensive periosteal and nutrient artery disruption, the risk of infection and non-union is substantially increased. The nutrient foramen is a landmark identified on tibial lateral X-ray as a curved lucent line in the posterior cortex.

Pathology

Common Injuries & Conditions

Tibial Endosteal Vascular Disruption

Loss of tibial nutrient artery supply from high-energy tibial fracture or aggressive reaming producing cortical devascularisation and increased infection and non-union risk in open tibial fractures.