Vascular anatomy and microcirculation of skeletal zones vulnerable to osteonecrosis: Vascularization of the femoral head
Johnson, Elizabeth O.
Soucacos, Panayotis N.
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Regardless of the type or location, bone is a highly vascular structure with unique features in its internal blood flow. Changes that occur in blood flow through bone have important implications in orthopedic surgery and disease. Several attempts have been made to correlate vascular patterns with the clinical incidence of osteonecrosis. Examination of the arterial anatomy of bones that undergo osteonecrosis in other regions of the body has allowed identification of the type of vascular interruptions that place particular bones at risk. The blood supply to the proximal end of the femur can be divided into three major groups: (1) an extracapsular arterial ring located at the base of the femoral neck; (2) ascending cervical branches of the arterial ring on the surface of the neck; and (3) arteries of the ligamentum teres. Although the role of an impaired blood supply of the femoral head in the pathogenesis of osteonecrosis has not been clarified, several studies have found abnormal blood supply in patients with osteonecrosis.