retinacular arteries

RETINACULAR

ARTERIES

Rahilla Khatoon, Moza Al-Khulaifa, Irsalan Asif and James Alexander

Overview

Retinacular arteries

Role of the retinacular arteries

Childhood Adult

Failure

Treatment

Surgery

Complications

Vasculature of the femur

1. Illio-femoral artery

2. Ligamentum teres

3. Obturator artery

4. Femoral artery

5. Profunda femoris- 4a. perforating arteries

6. Lateral circumflex femoral artery (LCFA) -

5a. Ascending, 5b. Transverse and

5c.Descending

7. From the ascending – ascending cervical

arteries

8. Subsynovial

9. Medial circumflex artery

Pixgood.com, (2015). Pix For > Medial Circumflex Femoral Artery. [online] Available from: http://pixgood.com/medial-circumflex-femoral-artery.html

[Accessed 19 Mar. 2015].


ALPF Medical Research, (2015). Vascular Supply To The Femoral Head. Femoral head. [online] Available from: http//http://www.alpfmedical.info/femoral-head/vascular-supply-to-

the-femoral-head.html [Acessed 17 Mar 2015].

The Role

Vascularise femoral head.

Lateral retinacular artery –important

Anastomose at base

subsynovial interarticular ring.

Epiphyseal arteries supply head.

Koval, K., & Zuckerman, J. (2000). Hip fractures: a practical guide to management. Springer Science & Business

Media.

Change in role from childhood to

adulthood.

LFCA and artery of ligamentum teres

Posterosuperior lateral epiphyseal and posteroinferior retinacular

branch -4 years

Metaphyseal vessels < 3 years old, after 14-17years

14-17 years

physis blocks metaphyseal.

anastomoses between metaphyseal-epiphyseal vessels.

Woon, C. (2015). Proximal Femur Fractures - Pediatric - Pediatrics - Orthobullets.com. [online] Orthobullets.com. Available at:

http://www.orthobullets.com/pediatrics/4018/proximal-femur-fractures--pediatric [Accessed 14 Mar. 2015].

Change in role from childhood to

adulthood.

Arteries- intramedullary at neck.

Anastomose with obturator artery.

Epiphyseal cartilage prevents retinacular artery

vascularising the head.

Virtual Anatomy Lab: Study notes. (2015). 1st ed. [ebook] Ottawa, p.1. Available at:

http://www.med.uottawa.ca/research/edemonstrator/w1/en/EN-study-notes-week-1.pdf [Accessed 19 Mar. 2015].

Causes of failure

In fractures of the neck of the femur, the fate of the

head depends upon the residual vascularity.

Blood supply depends wholly on the retinacular and

foveolar vessels.

Displacement of the fragments is greatest when the

fracture line is vertical, and least when it is more

horizontal.

Ellis H, Mahadevan V. Clinical anatomy. Chichester, West Sussex, UK: Wiley-Blackwell; 2013.

Snell R. Clinical anatomy by systems. Philadelphia: Lippincott Williams & Wilkins; 2007.

Michelson J, Riley L. Considerations in the comparison of cemented and cementless total hip prostheses. The Journal of Arthroplasty. 1989;4(4):327-334.

Causes of failure

The nearer the fracture to the femoral head, the

weaker the retinacular blood supply

Hip resurfacing can also disrupt the retinacular blood

flow.

This is because as part of the procedure they

sacrifice a branch of the medial circumflex femoral

artery.

Depending on how much of the head has lost blood

supply, will determine its salvation.Ellis H, Mahadevan V. Clinical anatomy. Chichester, West Sussex, UK: Wiley-Blackwell; 2013.

Snell R. Clinical anatomy by systems. Philadelphia: Lippincott Williams & Wilkins; 2007.


Sorensen L. Wound Healing and Infection in Surgery. Arch Surg. 2012;147(4):373.

Polismed.com. Index of /upfiles/other/artgen/134 [Internet]. 2015 [cited 22 March 2015]. Available from:

http://www.polismed.com/upfiles/other/artgen/134/

Design considerations of the hip

implant Cemented or cement-less hip prosthesis

Unibody or modular femoral stems

Material consideration

Cemented or cementless acetabular component

Single component acetabular cup or modular cup

Bearing surfaces


Hip resurfacing

Adolescence/minor necrosis

Bone preservation

Bone is sculpted to accept a cap/short stem

Replacement acetabulum needed

Increased amount of femoral neck fracture

Heterotopic ossification

Laskin RS, Su EP, Padgett DE. Hip Resurfacing: an Overview [online]. Available from: http://www.hss.edu/conditions_hip-resurfacing-overview.asp#.VQ_lrfmzKG4 [Accessed

14/03/15]

Surgical Procedure

Minimally invasive surgery

Small incisions (<10cm)

Acetabulum templating

Femoral templating

Size depends on cement/uncement

Modular

Marya, S. K. S, and R. K Bawari. (2010) Total Hip Replacement Surgery. New Delhi: Jaypee Brothers

Medical

Complications

Wear & corrosion products

Inflammation

Infection

Thrombosis

Nerve damage

Loosening

Leg length discrepancy

Ochsner, P.E. (2003) Total Hip Replacement. Berlin: Springer

Clinical case study

41 years old male.

Pain killers and anti-inflammatories.

Radiographs

chiropractor

Antalgic limp

Karim, R., & Goel, K. D. (2004). Avascular necrosis of the hip in a 41-year-old male: a case study. The Journal of the

Canadian Chiropractic Association, 48(2), 137.

Diagnosis and Treatment

MRI

EMG

Right hip limited motion

Increased pain in abduction

and internal rotation.

Cementless total hip

replacement.

Karim, R., & Goel, K. D. (2004). Avascular necrosis of the hip in a 41-year-old male: a case study. The Journal of the

Canadian Chiropractic Association, 48(2), 137.

Summary


Increasing importance in adulthood

Femoral neck fractures

Hip implants

Surgical considerations

Complications

retinacular arteries

Health & Medicine