MUSCULAR SYSTEM 4 Introduction to Lower
As long as the epiphyseal cartilage remains, no
Extremities
Gluteal Region, Posterior thigh, Hip Joint,
Posterior Thigh
Popliteal Fossa, Posterior Leg, Sole of Foot
Hip Joint
3. Discuss avascular necrosis of the femoral head.
4. Show radiographs of normal hip joint.
Definition:
Area not receiving sufficient blood supply
Cell Death due to ischemia
Anatomic knowledge of the blood supply to the femoral head
explains why avascular necrosis of the head can occur after
fractures of the neck of the femur. In the young, the epiphysis
of the head is supplied by a small branch of the obturator artery,
which passes to the head along the ligament of the femoral head.
The upper part of the neck of the femur receives a profuse blood
supply from the medial femoral circumflex artery. These branches
pierce the capsule and ascend the neck deep to the synovial
membrane.
communication occurs between the two sources of blood. In
the adult, after the epiphyseal cartilage disappears, an anastomosis
between the two sources of blood supply is established. Fractures of
the femoral neck interfere with or completely interrupt the blood
supply from the root of the femoral neck to the femoral head. The
scant blood flow along the small artery that accompanies the round
ligament may be insufficient to sustain the viability of the femoral
head, and ischemic necrosis gradually takes place.
Causes & Riskfactors:
atraumatic causes/risk factors include the following
Excessive corticosteroid usage and alcohol
abuse account for as many as 90% of new cases.
Intravascular coagulation appears to be the
central event associated with nontraumatic AVN.
(See also the Medscape Reference article
Disseminated Intravascular Coagulation.)
Coagulation may occur secondary to
extravascular compression (eg, marrow fat
enlargement), vessel wall injury (eg,
 chemotherapy, radiation), or a thromboembolic
event (eg, fat emboli).

Ischemic insult to the femoral head results in

infarcted subchondral bone. In this situation,
weakened and unrepaired necrotic bony
trabeculae fail under a compressive load,
leading to subchondral collapse (ie, crescent
sign) and, ultimately, articular collapse.

Traumatic causes of femoral head AVN include the

following:Femoral neck fractures Hip dislocation

Diagnostic Procedures:
MRI,X-Ray & Staging: Ficat 0-6, CT SCAN & Xrays