Paediatric hip

Paediatric Hip Anatomy

1. Femoral Head Blood Supply

The blood supply to the femoral head varies with the maturity of the growth plate. There are three primary sources:

Main Sources of Blood Supply

  1. Lateral Epiphyseal Artery (LEA)
    • Primary vessel: Originates from the subsynovial ring anastomosis.
    • Main contributor: Medial Femoral Circumflex Artery (MFCA) supplies the subsynovial ring.
  2. Metaphyseal Intraosseous Vessels
    • Provides blood supply by entering the femoral head as the physis develops.
  3. Ligamentum Teres
    • Plays a minimal role initially but becomes more significant in older children.

Blood Supply Development by Age

Age Group Blood Supply Characteristics
Birth to 4 years - Metaphyseal vessels dominate, entering the area where the physis will form.
- LEA also important.
- Ligamentum teres plays a negligible role.
4 to 7 years - LEA predominates as the sole blood supply due to the fully established physis, which prevents entry of metaphyseal vessels.
7 to 13 years - LEA supplies 80% of blood.
- Ligamentum teres contributes 20%, forming anastomoses with LEA.
>13 years - Adult blood supply pattern.
- LEA and metaphyseal vessels grow into the femoral head as the physis fuses.
- Ligamentum teres maintains its role.
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