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
- Lateral Epiphyseal Artery (LEA)
- Primary vessel: Originates from the subsynovial ring anastomosis.
- Main contributor: Medial Femoral Circumflex Artery (MFCA) supplies the subsynovial ring.
- Metaphyseal Intraosseous Vessels
- Provides blood supply by entering the femoral head as the physis develops.
- 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. |