Vascular anatomy and blood supply to the femoral head fig. In this paper, femoral head specimens were perfused by the inferior artery. Precise understanding of the major vascular branches to the femoral head would allow for complete or selective ligation of its blood supply and enable the creation of a reproducible bipedal model of femoral head osteonecrosis. Pdf anatomy of the medial femoral circumflex artery and its. The head of the femur is attached to the femoral shaft by the femoral neck, which varies in length depending on body size. Presentation by moritz tannast switzerland entitled blood supply of the femoral head and its surgical implications during the ehsefort advanced instructional course in bern, switzerland. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis. It can lead to pain and limping, hip collapse, and cause the legs to be of unequal length. Perthes disease is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur.
Avascular necrosis of the femoral head anfh is a degenerative condition which causes the upper ends of the thigh bones femurs to break down due to a disrupted blood supply and poor bone repair. Pdf blood flow to the femoral head and the posterior surgical. A detailed understanding of the blood supply to the femoral head is. What is the blood supply to the hip joint and why is it relevant to the. Avascular necrosis avn is a disease where there is cellular death of bone component due to interruption of the blood supply.
Blood supply to femoral head wheeless textbook of orthopaedics. The femur is the only bone in the thigh and the longest bone in the body. The blood supply of the femoral head has been summarized by trueta and harrison 1953, sevitt and thompson 1965 and judet and collaborators 1981 after decades of research fig. Osseous vascular anatomy has always been clinically relevant to orthopaedists, but its importance is sometimes overlooked. The nutrition of the femoral head is furnished by the medial circurn. Pdf file of the complete article 480k, or click on a page image below to browse page by page. Pdf on oct 1, 2016, hiran amarasekera and others published blood flow to the femoral head and the posterior surgical approach. The lateral epiphyseal vessels branches of the medial femoral circumflex artery and vein. Description of the anastomosis between the medial femoral circumflex artery and inferior gluteal arteries at the hip. Femoral neck femoral head venous drainage arterial supply human femur.
Nonhodgkinslymphoma ofbone causing avascular necrosis. Femoral head fractures are rare traumatic injuries that are usually associated with hip dislocations. Precise understanding of the major vascular branches to the femoral head would allow for complete or selective ligation of its blood supply and enable the creation of a reproducible bipedal model. Its susceptibility to circulatory compromise is an ongoing source of concern to physicians who treat hip pathology. Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur thighbone is disrupted. Basic sciences blood supply of the femoral head youtube. Familial avascular necrosis of the femoral head genetic. Total crosssectional area of the femoral neck nutrient foramina. The main function of the hip joint is to support the body weight in both standing and running or walking. Ascending cervical branches arise from ring at base of neck.
Blood supply to the femoral head and avascular necrosis. The first page of the pdf of this article appears above. The ball of the hip joint is comprised of the head of the femur or thigh bone as it is more commonly known, whilst the concavity of the socket is created by the acetabulum, which is a cuplike depression within the pelvic bone. The practical importance of the blood supply of some bones and their related. The blood supply to the proximal femur internal fixation. The aim of this study was to investigate femoral head. This hlock mas fixcd in a 4 pcr cent solution of formeldcliydc for 30 days and thcn minutely dissected, special cure being given to the deep hranch of thc medial. Get a printable copy pdf file of the complete article 480k, or click on a page image below to browse page by page. The artery of the ligamentum teres contributes a minor but variable amount of femoral head blood flow, variably anastomosing with the lateral epiphyseal and short medial epiphyseal branches, although this supply alone is usually insufficient to adequately perfuse the femoral head. Femoral neck fractures orthopaedic trauma association. It is covered in synovium, so while it is intraarticular it is actually extrasynovial.
Arterial supply to the femoral head 725 for 10 minutcs. If you would like a large, unwatermarked image for your web page or. The surgical anatomy of the blood supply to the femoral head. Pdf the surgical anatomy of the blood supply to the femoral head. Article information, pdf download for arterial supply to the head of the femur. Decompressing the femoral head the simplest operation is to drill one or several holes through the femoral neck and into the femoral head, trying to reach the area that lacks blood supply. The femoral head is removed in total hip replacement surgery. Arterial blood supply to the femoral head is achieved through an anastomosis of three sets of arteries figure 6. Of these two, the medial is usually the from the department of orthopaedic surgery, university of pennsylvania school of medicine, philadelphia, pa. Pdf the inferior gluteal artery is described in standard anatomy textbooks as contributing to the blood supply of the hip through an. The main blood supply to the femoral head is from the medial and lateral femoral circumflex arteries that are large branches of either the femoral or profundafemoris arteries. The traditional piriformis start site causes injury to the blood supply to the femoral head and must be avoided when rigid nail fixation is used in skeletally immature individuals. In the july 19, 2017 issue of the journal, rego et al. Ring is formed by branches of medial and lateral circumflex femoral arteries.
Extra capsular arterial ring formed posteriorly by mfca. Lesions of the femoral neck may interfere with the blood supply to the femoral capital epiphysis resulting in avascular necrosis. The rate of avn following ddh treatment ranges from 6% to 48%. When such changes are present on a radiograph especially in children over the age of 12 perthes disease is unusual over this age and the metaphyseal lesion in perthes is nearly always located well forward on the meta. The articles prior to january 20 are part of the back file collection and are not available with a current paid subscription. Blood supply of the femoral head europe pmc article. It decreases the pressure inside the femoral head it helps to stimulate budding of new blood vessels in affected areas reliving pressure helps in reduction of pain.
The blood supply of the upper end of the human femur, including. Blood supply of the femoral head pubmed central pmc. Avascular necrosis avn of the femoral head is a major complication following treatment for developmental dysplasia of the hip ddh. Drilling one or several holes through the neck of femur into areas of head where there is lack of blood supply principle. To evaluate the bleeding of the femoral head on hip osteoarthritis in patients who. It is caused by excessive pressure over the femoral head, which compromises its blood supply. After fracture, blood supply depends on retinacular vessels. Anatomic study on the blood supply to the femoral head following. Avascular necrosis of the femoral head physioworks. Avascular necrosis or osteonecrosis is a condition affecting the upper part of the leg specifically the femoral head.
Avascular necrosis an overview sciencedirect topics. Articles blood supply of the femoral head br med j 1953. From the anastomoses that contribute to the blood supply of the femoral head, the most important is the anastomosis with the iga via the piriformis. Research has identified some factors that may predispose children to perthes disease. Hip dislocations and femoral head fractures orthopaedic trauma. Intraarticular isolation of the femoral head and neck makes it highly dependent on its tenuous vascular supply. Blood supply of the femoral head is derived from 2 vascular systems the posterosuperior and the posterioinferior from multiple small vessel supply at birth these two vascular system evolve over 1824 months these are from the medial circumflex artery. In orthopedic surgery, the head of the femur is important because it can undergo avascular necrosis and consequent osteochondritis dissecans. Illustration demonstrating that the blood supply to the femoral head is compromised by subcapital femoral fractures or slipped capital femoral epiphysis. Thirty minutcs latcr hoth hip joints including the uppcr cnd of thc femur and the lower part of thc pelvis were carcfully rcmovcd.
Blood supply to the femoral head is provided by a single blood vessel there is a lot of interest as to why some children have a loss of blood supply and others do not. Vascular anatomy and blood supply to the femoral head. It acts as the site of origin and attachment of many muscles and ligaments, and can be divided into three parts. Avascular necrosis of the capital femoral epiphysis after intramedullary nailing for a fracture of the femoral shaft. Avascular necrosis usually affects people between 30 and 50 years of age. The surgeon is then able to fully visualize and correct abnormalities of bone and soft tissues. Another source of blood supply, also originating from the mfca, is the posterior inferior nutrient artery. Pdf download for anatomic study on the blood supply to the femoral head. The drill bores out a plug of bone within the femoral head. The arterial supply to the femoral head in children. Essentially, the femoral head or ball of your hip joint receives less and less blood supply. Blood supply medial femoral circumflex artery mfca main blood supply to the weightbearing portion of the femoral head.
You may not embed one of our images on your web page without a link back to our site. Rehabilitation guidelines for surgical hip dislocation. Micro perfusion and quantitative analysis of the femoral. The principal vessels ascend in the synovial retinaculum, which is a reflection of the ligamentous capsule onto the neck of the femur. Links to pubmed are also available for selected references. Age 8 the ligamentum teres has increasing significance in supply 20% trueta suggested that did not supply until 3. Regarding the vascular anatomy of the hip, the literature presents few studies. Treatment may be nonoperative or operative depending on the location of the fracture and degree of fracture displacement. From this distal attachment, capsular fibres are reflected on to the femoral neck as retinacula and provide one pathway for the blood supply to the femoral head 4the capsule of the hip is attached proximally to the margins of the acetabulum distally, it is attached along. Effects of hip traction on the blood supply of femoral. If there is a fracture of the neck of the femur, the blood supply through the ligament becomes crucial.
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