- See:
-
Anastomosis of lower limb arteries
-
Arterial supply of the femur
-
AVN of femoral head;
-
AVN following femoral neck fracture:
- Anatomy:
- extracapsular arterieal ring at the base of the femoral neck;
- formed posteriorly by large branch of
MFCA
- formed anteriorly by smaller branches of
LFCA;
-
superior &
inferior gluteal artery have minor contributions;
- ascending cervical branches
- these give rise to
retinacular arteries;
- gives rise to
subsynovial intra articular ring
- artery of ligamentum teres;
- derived from
obturator or
MFCA;
- inadequate to supply femoral head with displaced fractures;
- forms the medial epiphyseal vessels;
- only small & variable amount of the femoral head is nourished by artery of ligamentum teres;
- epiphyseal blood supply:
- arises primarily from lateral epiphyseal vessels that enter head posterosuperiorly;
- vessels from medial epiphyseal artery entering thru ligamentum teres;
- epiphyseal arterial branches:
- arise as arteries of
subsynovial intraarticular ring;
- two groups of epiphyseal arteries: lateral & inferior vessels;
- metaphyseal blood supply:
- arises from extracapsular arterial ring;
- arise from branches of
ascending cervical arteries, &
subsynovial intra articular ring;
- Changes w/ Age:
- even after closure of
epiphyseal plate, there is minimal astomosis between epiphyseal and metaphyseal circulations;
- in the adult, greatest portion of blood supply to head of femur is derived from vessels on posterior superior surface of femoral neck;
- Femoral Neck Frx:
- frx disrupts intraosseous cervical vessels;
- portion of the neck that is intracapsular has essentially no cambium layer in its fibrous covering to participate in peripheral callus formation;
- hence, healing is dependent on endosteal union alone;
- femoral head nutrition is then dependent on remaining
retinacular vessels, & supply from the ligamentum teres;
- position acheived at
reduction is significant factor in development of
avascular necrosis:
- in frx of hip, valgus reduction may end up kinking of lateral epiphyseal vessels & tethering of
medial epiphyseal vessels in ligamentum teres;
- valgus and rotatory malposition may result in
AVN;
Intracapsular pressure and caput circulation in nondisplaced femoral neck fractures.
Intraosseous pO2 in femoral neck fracture. Restoration of blood flow after aspiration of hemarthrosis in undisplaced fractures.
The arterial supply of the developing proximal end of the human femur.
Vascularity of the hip labrum: A cadaveric investigation.
Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis.
