title: The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography.
abstract: The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation. Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN.
authors.affiliation: The Medical Centre of Postgraduate Education, Gruca Teaching Hospital, Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Konarskiego 13, 05-400 Otwock, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Zlotorowicz
authors.forename: J
authors.initials: J
authors.lastname: Czubak
authors.forename: A
authors.initials: A
authors.lastname: Caban
authors.forename: P
authors.initials: P
authors.lastname: Kozinski
authors.forename: R
authors.initials: R
authors.lastname: Boguslawska-Walecka
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography / Q000379:methods*; D005260:Female; D005270:Femur Head / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006615:Hip / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006617:Hip Dislocation / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: Avascular necrosis; CT angiography; Deep branch; Fracture dislocation; Hip dislocation; Hip joint; MFCA; Medial femoral circumflex artery