Epiphyseal Arterial Network and Inferior Retinacular Artery Seem Critical to Femoral Head Perfusion in Adults With Femoral Neck Fractures

• Published in: Clinical orthopaedics and related research 2017-08, Vol.475 (8), p.2011-2023
• Main Authors: Zhao, Dewei, Qiu, Xing, Wang, Benjie, Wang, Zihua, Wang, Wei, Ouyang, Jun, Silva, Rona M., Shi, Xiaotian, Kang, Kai, Xu, Dachuan, Li, Chuang, Zhong, Shizhen, Zhang, Yu, Pinkerton, Kent E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angiography; Angiography, Digital Subtraction; Arteries; Arthroplasty; Basic Research; Blood; Cadaver; Case-Control Studies; Computed tomography; Conservative Orthopedics; Drilling; Epiphyses - blood supply; Epiphyses - diagnostic imaging; Epiphyses - surgery; Female; Femoral Artery - diagnostic imaging; Femoral Artery - physiopathology; Femoral Artery - surgery; Femoral Neck Fractures - diagnostic imaging; Femoral Neck Fractures - physiopathology; Femoral Neck Fractures - surgery; Femur; Femur Head - blood supply; Femur Head - diagnostic imaging; Femur Head - surgery; Fractures; Hip; Hip - surgery; Hip joint; Humans; Joint surgery; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Perfusion; Sports Medicine; Surgery; Surgical Orthopedics; Vascular system; Veins & arteries; X-Ray Microtomography; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-017-5318-5

Background A better understanding of the blood supply of the femoral head is essential to guide therapeutic strategies for patients with femoral neck fractures. However, because of the limitations of conventional techniques, the precise distribution and characteristics of intraosseous arteries of the femoral head are not well displayed. Questions/purposes To explore the characteristics and interconnections of the intraosseous vessel system between different areas of the femoral head and the possible blood supply compensatory mechanism after femoral neck fracture. Methods The three-dimensional (3-D) structures of the intraosseous blood supply in 30 uninjured normal human femoral heads were reconstructed using angiography methods and microCT scans. The data were imported in the AMIRA ® and MIMICS ® software programs to reconstruct and quantify the extra- and intraosseous arteries (diameter, length). In a separate experiment, we evaluated the residual blood supply of femoral heads in 27 patients with femoral neck fractures before surgery by analyzing digital subtraction angiography data; during the study period, this was performed on all patients in whom hip-preserving surgery was planned, rather than arthroplasty. The number of affected and unaffected subjects included in the three groups (superior, inferior, and anterior retinacular arteries) with different types of fractures (Garden Types I–IV) were recorded and analyzed (Fisher’s exact test) to reflect the affected degrees of these three groups of retinacular arteries in patients after femoral neck fractures. Results The main results of our cadaver study were: (1) the main blood supply sources of the femoral head were connected by three main network structures as a whole, and the epiphyseal arterial network is the most widely distributed and the primary network structure in the femoral head; (2) the main stems of the epiphyseal arteries which were located on the periphery of the intraosseous vascular system have fewer anastomoses than the network located in the central region; (3) compared with the round ligament artery and anterior retinacular artery, the inferior retinacular artery has a relatively large caliber. Digital subtraction angiography of the 27 patients with hip fractures indicated that the inferior retinacular arterial system had a high likelihood of being unaffected after femoral neck fracture (100% [14 of 14] in nondisplaced fractures and 60% [six of 10] in Garden Type III fractures). Concl