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Blood Supply to Femoral Head & Neck

- 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; 
         - ref: The ligamentum teres of the adult hip
    - 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

The relative contribution of the medial and lateral femoral circumflex arteries to the vascularity of the head and neck of the femur: a quantitative MRI-based assessment.

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.

The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip

Capsular and Pericapsular Contributions to Acetabular and Femoral Head Perfusion

Vascular Supply to the Acetabular Labrum