|
Deep Branch of the Medial femoral circumflex artery (MFCA) is the primary source for the blood supply of the head of the femur In posterior approaches to the hip and pelvis the short external rotators are often divided. This can damage the deep branch and interfere with perfusion of the head. Trochanteric branch at the proximal border of quadratus femoris spreads on to the lateral aspect of the greater trochanter. This branch marks the level of the tendon of obturator externus, which is crossed posteriorly by the deep branch of the MFCA. As the deep branch travels superiorly, it crosses anterior to the conjoint tendon of gemellus inferior, obturator internus and gemellus superior. It then perforates the joint capsule at the level of gemellus superior. In its intracapsular segment it runs along the posterosuperior aspect of the neck of the femur dividing into two to four subsynovial retinacular vessels. The obturator externus protects the deep branch of the MFCA from being disrupted or stretched during dislocation of the hip in any direction after serial release of all other soft-tissue attachments of the proximal femur, including a complete circumferential capsulotomy. Maintaining the external rotators maintains the blood supply to the femoral head. Superior-lateral retinacular vessels must also be maintained during femoral neck osteoplasty. Lateral epiphyseal artery, which is the terminal branch of the medial femoral circumflex artery of the profunda femoris circulation supplies the majority of the femoral head.(Trueta, JBJS 35B:442;1953). Blood supply to the femoral head can be injured during trochanteric osteotomy for surgical hip dislocation. Medial Femoral Circumflex Artery References: Ganz R, Gill TJ, Gautier E, et al: Surgical dislocation of the adult hip: A technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83:1119-1124. PubMed Gautier E, Ganz K, Krugel N, et al: Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000;82:679-683. PubMed |