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Blood supply of femoral head at various ages

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Leg Calve Perthes disease
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Blood supply of femoral head at various ages

  1. 1. PRESENTER: Dr.SANDEEP TRIPATHI MODERATOR :PROF M.CHANDRASEKARAN
  2. 2. BLOOD SUPPLY TO THE FEMORAL HEAD: At birth: Vessels from lateral side: lateral epiphyseal artery No ligamentum teres
  3. 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. 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. 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. 6. 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
  7. 7. SOCIAL CONDITIONS - Usually belong to lower socioeconomic status, reflects dietary and environmental factors TRAUMA . GENETIC FACTORS - Inheritance 2-20%;
  8. 8.  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
  9. 9. 1) Incipient stage or synovitis stage: - Lasts for 1-3 weeks - Synovium hyperaemic, swollen
  10. 10. 2) Stage of avascular necrosis: - Dead trabecular bone - Collapsed trabeculae - Thickened articular cartilage Physeal disruption - Cartilage extending from the physis into the metaphysis
  11. 11. 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

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