The document discusses the vascular supply to the femoral head from birth through adolescence. It notes that in early childhood, the main blood supply is from the lateral epiphyseal arteries and metaphyseal branches. From ages 4-7, the only source is the lateral epiphyseal arteries due to ossification. In adolescence, the ligamentum teres vessels and extracapsular arterial ring also contribute. The document then discusses Perthes disease, noting it results from loss of blood supply to the femoral head, commonly affects males ages 3-10, and progresses through stages including avascular necrosis, fragmentation, and eventual healing.
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Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
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This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
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It is a power point presentation by Dr Zobayer Mahmud Khan while he was taking a lecture class of this topic in Sir Salimullah Medical College, Mitford, Dhaka. Here the venous drainage and the lymphatic drainage are stated clearly with many of the clinical events. Hope you can learn from here. Photographs used here are collected from The "Essential of human Anatomy (inferior extremity) by A.K. Datta".
The main artery of the lower limb is the femoral artery. It is a continuation of the external iliac artery (terminal branch of the abdominal aorta). The external iliac becomes the femoral artery when it crosses under the inguinal ligament and enters the femoral triangle.
In the femoral triangle, the profunda femoris artery arises from the posterolateral aspect of the femoral artery. It travels posteriorly and distally, giving off three main branches:
Perforating branches – Consists of three or four arteries that perforate the adductor magnus, contributing to the supply of the muscles in the medial and posterior thigh.
Lateral femoral circumflex artery – Wraps round the anterior, lateral side of the femur, supplying some of the muscles on the lateral aspect of the thigh.
Medial femoral circumflex artery – Wraps round the posterior side of the femur, supplying its neck and head. In a fracture of the femoral neck this artery can easily be damaged, and avascular necrosis of the femur head can occur.
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2. BLOOD SUPPLY TO THE FEMORAL HEAD:
At birth:
Vessels from lateral side: lateral epiphyseal artery
No ligamentum teres
3. 4 MONTHS TO 4 YEARS:
Epiphyseal ossification begins.
Ascending cervical branches.( metaphyseal and
lateral epiphyseal vessels)
After 4 months metaphyseal branches decrease.
4. 4 TO 7 YEARS
Epiphyseal plate is firm barrier between epiphysis
and metaphysis.
Only source is lateral epiphyseal arteries
9-10 YEARS
Ligamentum teres vessels becomes prominent.
Anastomose with lateral epiphyseal vessels.
5. ADOLESCENT PERIOD:
Growth plate extends beneath both epiphysis
EXTRACAPSULAR ARTERIEAL RING
ASCENDING CERVICAL BRANCHES
(retinacular arteries )
ARTERY OF LIGAMENTUM TERES
EPIPHYSEAL BLOOD SUPPLY
METAPHYSEAL BLOOD SUPPLY
6.
7.
8. VASCULAR SUPPLY
INCREASED INTRA-ARTICULAR PRESSURE
INTRAOSSEOUS PRESSURE
venous drainage in the femoral head is impaired, causing
an increase in intraosseous pressure
COAGULATION DISORDER
- Increase in serum levels of lipoproteins,thrombogenic
substance
9. SOCIAL CONDITIONS
- Usually belong to lower socioeconomic status, reflects
dietary and environmental factors
TRAUMA
. GENETIC FACTORS
- Inheritance 2-20%;
10. perthes disease may be defined as the “disease
of the hip, limited sharply by age group and
largely by sex, it results from changes in capital
femoral epiphysis, apparently secondary to loss
of an adequate blood supply for at least a
portion of head.”
Age group: 3-10 years
Sex: males 4-5 times more than girls
Bilateral in 10-12% of patients
11. 1) Incipient stage or
synovitis stage:
- Lasts for 1-3 weeks
- Synovium hyperaemic,
swollen
12. 2) Stage of avascular
necrosis:
- Dead trabecular bone
- Collapsed trabeculae
- Thickened articular
cartilage Physeal
disruption
- Cartilage extending
from the physis into the
metaphysis
13. 3) Fragmentation stage
Invasion of vascular granulation tissue
- New bone forming on old trabeculae
4) HEALING STAGE
- Normal forming bone alongside replacing
slowly resorbing bone.
- New bone, woven and lamellar
- Mushroom shaped contour.
- Soft tissues fibrotic, motion restricted.
- Return to normal architecture
