Vascular anatomy and microcirculation of skeletal zones vulnerable to osteonecrosis: vascularization of the femoral head

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Circulation within bones

The circulation and arrangement of blood vessels in long bones have been disputed for many years, and today many aspects still remain controversial. The most widely accepted patterns of intraosseous circulation are those proposed by Brooks in 1971 [3], [4].

Bones have multiple arterial inlets and venous outlets [5], [6]. Long bones have four arterial inputs: the nutrient artery, periosteal arteries, metaphyseal arteries, and epiphyseal arteries. Although these arteries have been recognized for

Microcirculation of bone

Two types of microcirculation exist in long bones: marrow and cortical [10]. The interrelationship of the two circulations remains largely unresolved. Some believe that the marrow and cortical microcirculations are arranged as a portal system in which arterial blood first passes through medullary sinusoids and then perfuses the cortical capillaries [12]. A second, more widely accepted hypothesis is that the two microcirculations are distinct [13]. Normally, the intramedullary branches of the

Vascularization of the femur

Vascularization of the femur is considered at the level of its macrocirculation (eg, it connection with systemic circulation) and microcirculation in cortical and cancellous bone. The femoral artery, a continuation of the external iliac, is the chief artery of the lower limb. It extends from the level of the inguinal ligament (midway between the anterior superior iliac spine and the pubic symphysis) to the lower border of the popliteus, where it divides into the anterior and posterior tibial

Identification of arterial patterns at risk

Several attempts have been made to correlate vascular patterns with the clinical incidence of osteonecrosis. Examination of the arterial anatomy of bones that undergo osteonecrosis in other regions of the body has allowed identification of the type of vascular interruptions that place particular bones at risk. Purely intraosseous disruption can result in avascular necrosis in the scaphoid and capitate, whereas extraosseous disruption seems sufficient to produce necrosis in the femoral head and,

Summary

Regardless of the type or location, bone is a highly vascular structure with unique features in its internal blood flow. Changes that occur in blood flow through bone have important implications in orthopedic surgery and disease. Several attempts have been made to correlate vascular patterns with the clinical incidence of osteonecrosis. Examination of the arterial anatomy of bones that undergo osteonecrosis in other regions of the body has allowed identification of the type of vascular

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