· 4 groups of arteries
Cruciate
· primary
· at centre of lesser trochanter
· formed
· posteriorly by transverse branch of MCFA
· anteriorly by transverse branch of LCFA
· superiorly from descending branch of inferior gluteal a
· inferiorly from ascending branch of 1st perforator
Trochanteric
· at greater trochanter
· formed by
· ascending branch of inferior
· descending branch of superior
· ascending branch of MCFA
· ascending branch of LCFA
· at base of femoral neck
· formed
· posteriorly by transverse branch of MCFA
· anteriorly by transverse branch of LCFA
· MCFA is most important
· branches of extracapsular ring
· divided into four groups
· anterior, posterior, medial, lateral
· MFCA gives rise to posterior, medial and lateral branches
· LFCA gives rise to anterior branches
· lateral branches (from MFCA) supplies most of blood to femoral head and neck
· penetrate capsule at femoral attachment
· anteriorly at intertrochanteric line
· posteriorly halfway up femoral neck
· pass upwards on surface of neck of femur
· called retinacular arteries
· form subsynovial intra-articular ring
· at margin of articular cartilage on neck of femur
· may be complete or incomplete
· ring gives rise to branches that enter head of femur
· called epiphyseal arteries
· branch of obturator a or MFCA
· variable supply
· usually unimportant with small subsynovial circulation
· may give large artery to supply substantial part of head
· usually insufficient if other sources interrupted
· less than age 4
· contribution from metaphysis
· age 4-8 yrs
· exclusively epiphyseal vessels
· after than age 8
· increased contribution from ligamentum teres
· tenuous supply
· from
· branches of subsynovial intra-articular ring (lateral epiphyseal arteries)
· artery of ligamentum teres (medial epiphyseal artery)
· anastomoses with metaphyseal arteries
· excellent supply
· from
· branches of extracapsular arterial ring
· branches of ascending cervical arteries
· branches of subsynovial intra-articular ring
· intramedullary branches of superior nutrient artery
· anastomoses with epiphyseal vessels
Artery of tarsal canal
· arises from posterior tibial artery 1 cm proximal to division
· passes anterior to FDL
· enters tarsal canal
· only other structure in canal is interosseous talocalcaneal ligament
· gives off branches that enter talus
· on medial side
· inferiorly from tarsal canal
· continues to tarsal sinus
· anastomoses with arteries in tarsal sinus
Deltoid branch
· important branch from artery of tarsal canal
· lies between leaves of deltoid ligament
· sends branches that enter through medial surface of body of talus
· responsible for supply to medial half of body
Superior neck branches
· branches from dorsalis pedis
Artery of tarsal sinus
· formed by anastomosis of
· branch of dorsalis pedis as it croosses the navicular
· branch of perforating peroneal artery
· gives branches that enter lateral side of talus
· supplies lateral half of body
· unimportant
· contribute to plexus around posterior talus
· perforating branch contributes to artery of tarsal sinus
· medially
· branches of dorsalis pedis
· laterally
· branches of artery of tarsal sinus
· laterally
· from artery of tarsal sinus
· middle part
· from branches of anastomosis between artery of tarsal sinus and tarsal canal
· medially
· from deltoid artery from artery of tarsal canal
· majority of supply from palmar and dorsal branches of radial artery
· enters distally at tuberosity
· accounts for 20-30% of supply at distal pole
· enter through dorsal ridge in middle 1/3 of bone
· supply remainder of vascularity