What is the functional anatomy of the hip relevant to hip fractures?

Updated: Jan 08, 2019
  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

The hip is a ball-and-socket joint composed of the acetabulum and the head of the femur. The femoral head is connected to the shaft by the femoral neck. These are supported by a network of trabecular bone.

Two other important landmarks on the proximal femur are the greater and lesser trochanters. These 2 structures are the main muscle attachment sites for the proximal bone. The iliopsoas muscle is connected to the lesser trochanter, and the abductors and short rotator muscles act through their insertion on the greater trochanter. In addition, many additional muscles attach along the intertrochanteric line, and, along with the muscles, they bring with them an abundant and redundant blood supply, which is conducive to healing. This is in contrast to the intercapsular femoral neck, which is prone to healing complications.

The blood supply to the femoral head has been studied extensively and has been found to change substantially during development. Until the cartilaginous growth plate forms a barrier at age 4 years, the major blood supply comes from the medial and lateral circumflex arteries (metaphyseal arteries), which arise from the deep femoral artery. After age 4 years, the posterosuperior and posteroinferior arterial branches of the medial femoral circumflex bypass the growth plate and form the main blood supply to the femoral head. During adolescence, the growth plate fuses and the metaphyseal vessels again become significant, traveling along the femoral neck. Fractures in this area can disrupt this delicate blood supply, leading to AVN, the most severe complication of this fracture.


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