July 18, 2024

Vascular Supply of proximal femur changes as the age advances and has clinical significance as its injury can leads to avascular necrosis of femoral head.

It is important in pathogenesis of Perthe’s disease.

Vascular Supply of Proximal Femur
Vascular Supply of Proximal Femur

At base of femoral neck and at the level of capsular attachment, extracapsular ring of attachment is formed. In which,

  • Posterior portion is formed by Medial circumflex artery
  • Anterior portion is formed by lateral circumflex artery

Branches of the ring arises at regular interval

Blood flows upward to femoral neck and head and downward laterally to tronchanter/ base of neck

Ascending branches from arterial ring will penetrate the capsule along IT line

It pass upward to synovial reflection towards junction of articular cartilage  and femoral neck where it forms the intraarticular subsynovial arterial ring forms (circulus articulis vasculosus of hunter)

Arteries of ligamentum teres generally arise form

  1. Obturator artery
  2. Medial circumflex femoral artery

Medial circumflex femoral artery

Medial circumflex femoral artery arises directly from femoral artery/ profundus (at the point of origin).

Branch of its, lateral ascending cervical artery which courses upward to the superior surface of neck. After giving metaphyseal vessel to neck it sends prominent vessels called the lateral epiphyseal vessels

Lateral circumflex femoral artery

Lateral circumflex femoral artery gives branches, called

Ascending cervical arteries

  1. Retinacular arteries
  2. Lateral and medial metaphyseal arteries
  3. Rami nutricii capitis

Derived from the extracapsular arterial ring

Penetrate capsule at the base of neck

Pass beneath synovium

Branches supply to metaphysis and epiphysis

Epiphyseal branches crosses epiphyseal plate

Supply to secondary ossification centre.

Vascular arrangement at birth and variation with advancing growth

Blood supply of head is derived from 3 sources:

Medial Ascending cervical vessels ( Inferior metaphyseal of trueta)

  • 6- 15 straight vessels: vertically to top of head
  • Cauliflower like arrangement of capillaries

Lateral ascending cervical vessels(Lateral epiphyseal of trueta)

  • Consist of large group of vessels
  • Horizontally to centre of head
  • Cauliflower like arrangement of capillaries

Vessels of ligamentum teres

  • Supply only limited area at birth
  • Radiating  (like laural leaf) in character

Phase 1: At birth

Vessels coming from lateral side of head will course horizontally towards medial side

Vessels coming from top of  ossified shaft will course vertically through cartilaginous head

Vessels from the ligamentum teres are insignificant/absent

Phase 2: Infantile (4 month-4 years)

At 4 months, epiphyseal ossification begins

Blood supply starts from ascending cervical arteries

Metaphyseal arteries decreases in number (growth plate starts developing)

Lateral epiphyseal arteries has a Major role

Phase 3: Intermediate (4-7 years)

Epiphyseal plate will form a major barrier for blood supply

Only source available is Lateral epiphyseal Vessels

Phase 4: Pre-adolescence (9-10 years)

After 7 years, ligamentum teres vessels become more prominent which extend deeper into epiphysis and anastomosis with lateral epiphyseal vessels

These are termed as medial epiphyseal arteries.

Phase 5:Adolescent Period

At puberty, trochanter has ossified

Lateral epiphyseal vessels will contribute as a major source

Ligamentum teres become increasingly prominent

Phase 6: Adult period

Lateral epiphyseal artery will supply major epiphysis portion

Inferior metaphyseal artery: 2/3rd of the metaphysis tissue lies within femoral head

Round Femoral Head: Epiphysis ( above scar) + metaphysis extending from femoral neck