The Distribution and Anastomoses of Arteries Supplying the Head and Neck of the Femur

Abstract

1. At necropsy the arterial distribution within the head and neck of the femur was investigated by arteriographic injection in fifty-seven uninjured hips of mostly elderly subjects. 2. Before injection all vessels to the head except for one or more particular groups were divided. 3. The superior retinacular arteries were found to be the most important arterial supply to the head. Through the widely distributed branches of their lateral epiphysial vessels (superior capital) they supplied the superior, medial, central and usually the lateral parts of the head: through anastomoses they could also supply the anterior and posterior segments, the subfovea and the inferior sector, which receive separate contributions. Sometimes the inferior or the lateral connections were defective. 4. The arteries in the ligamentum teres were either absent or unimportant for the head in most subjects. Either the vessels in the ligament never reached the head or they supplied only a limited subfoveal zone. In only one out of sixteen specimens was the whole head injected through the vessels of the ligamentum teres. 5. The inferior retinacular arteries were found to be of subsidiary importance and generally supplied a variable infero-lateral part of the head, particularly posteriorly. In a small number there was an anastomotic supply to other parts of the head, but only in two out of sixteen specimens was nearly all the head injected through these vessels. 6. The regular anastomotic supply from the superior retinacular arteries to the subfovea and to the inferior part of the head was in curious contrast to the infrequent anastomotic filling of the lateral epiphysial arteries from the inferior retinacular or ligamentum teres arteries. 7. Vessels within the femoral neck sometimes supplied the lateral part of the head but never the medial three-quarters. 8. The neck of the femur received important branches from the superior retinacular arteries but only in a small number (15 per cent) was part of it entirely dependent on this supply.

Microvascularization of the hypermineralized calcified fibrocartilage and cortical bone in the sheep proximal femur

“…However, with regard to the distinctive characteristics of each insertion, the present investigation was unique because it quantified the number of vessels in the calcified fibrocartilage and cortical bone of the proximal femur. Typically, investigations of the blood supply to the proximal femur have made qualitative macroscopic observations and have not examined the microvascularity or vessel density (Howe and Schwartz, 1950;Judet et al, 1955;Crock, 1965;Sevitt and Thompson, 1965). The present investigation observed that there were no regional differences in the vascular density of the cortical bone beneath the insertions of the dorsal neck and the greater and lesser trochanters.…”

“…Despite the importance of vascularity, there has been very little research into the microvascular supply to the proximal femur or to the tendon and ligament insertions in this region. A majority of the studies that have examined vascularity have focused on identifying the major blood vessels supplying this important structural region (Howe and Schwartz, 1950;Judet et al, 1955;Crock, 1965;Sevitt and Thompson, 1965;Gautier et al, 2000), and not on the microvasculature. In addition, it has recently been shown that up to 60% of the cortical shell of the human proximal femur is composed of a hypermineralized calcified fibrocartilage been shown at other anatomical sites to be an avascular tissue (Petersen and Tillmann, 1999;Benjamin et al, 2000).…”

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

“…The flap so created contains the deep branch of the medial femoral circumflex artery, the anastomoses with the inferior gluteal artery, and its retinacular end branches; it clearly is longer than with the retinacular tunneling produced with the classic Dunn procedure [14] and therefore allows better compensation of adverse stretching during manipulation. After developing the posterolateral flap portion, we created an anteromedial flap containing a constant branch of the medial femoral circumflex artery, running in the synovial surface of Weitbrecht's ligament and giving blood supply to the inferomedial portion of the epiphysis [43], again with strictly subperiosteal dissection. Both flaps were connected posteriorly and allowed circumferential access to the osseous neck.…”

A Animal Study of Immunohistochemical Analysis of Sympathetic Nerve Fibers in Osteonecrosis of Femoral Head in Comparison with Osteoarthritis

“…Atsumi et al & Sevitt et al [17,18]. found that there are no radiological necrosist onset, missing the vessels in the capsule of the upper femoral neck completely.…”

“…They found that there is no radiological necrosist onset, missing the vessels in the capsule of the upper femoral neck completely [17]. But these are just responsible for the vascularization of the greater part of the femoral head and the nerve fiber density of the femoral head as already Sevitt et al [18] has described.…”