From the Guidelines
The intracapsular head of the femur is primarily supplied by a limited vascular network, which is vulnerable to disruption in the event of a fracture, highlighting the importance of prompt and appropriate treatment to prevent complications such as avascular necrosis. The blood supply to the intracapsular head of the femur is not explicitly detailed in the provided study 1, but based on general medical knowledge, it is known that the medial femoral circumflex artery plays a crucial role in supplying the femoral head. This artery, along with contributions from the lateral femoral circumflex artery and the artery of the ligamentum teres, forms a vital network that supports the viability of the femoral head.
Key Points to Consider
- The risk of avascular necrosis following an intracapsular fracture underscores the importance of the vascular supply to the femoral head 1.
- The management of intracapsular fractures, as discussed in the study 1, focuses on preventing displacement and promoting healing to minimize the risk of long-term complications such as arthritis.
- The choice between different surgical treatments, such as hemiarthroplasty and total hip arthroplasty, depends on various factors including the patient's age and the specific characteristics of the fracture, with the goal of optimizing outcomes in terms of morbidity, mortality, and quality of life.
Clinical Implications
Given the potential for significant morbidity associated with intracapsular fractures of the femur, prompt recognition and appropriate management are critical to prevent long-term complications. This includes careful consideration of the vascular supply to the femoral head and the potential consequences of its disruption. The study 1 emphasizes the importance of surgical intervention in the management of these fractures, highlighting the need for a thorough understanding of the vascular anatomy and its role in determining patient outcomes.
From the Research
Blood Supply to the Intracapsular Head of Femur
The blood supply to the intracapsular head of the femur is primarily provided by the medial femoral circumflex artery (MFCA).
- The deep branch of the MFCA is the main artery responsible for supplying the femoral head 2.
- This branch perforates the joint capsule at the level of gemellus superior and runs along the posterosuperior aspect of the neck of the femur, dividing into two to four subsynovial retinacular vessels 2.
- The MFCA makes a greater contribution than the lateral femoral circumflex artery (LFCA) to the vascularity of the femoral head, with the MFCA supplying approximately 82% of the blood supply 3.
Anatomical Variations
There are variations in the origin of the MFCA and LFCA, with the most frequent type being both arteries originating from the deep femoral artery (DFA) 4, 5.
- In some cases, the MFCA may originate from the common femoral artery (CFA) or superficial femoral artery (SFA) 4, 5.
- The obturator artery, which is also involved in the blood supply to the hip joint, may have an atypical origin, known as corona mortis, in approximately 33% of patients 5.
Clinical Significance
Understanding the anatomy and variations of the blood supply to the intracapsular head of the femur is crucial for avoiding iatrogenic vascular injury during surgical interventions about the hip 2, 6, 5.