الفهرس | Only 14 pages are availabe for public view |
Abstract Surgical Hip Dislocation is a powerful technique employed by hip preservation surgeons for treatment of a variety of hip pathologies. The critical element of this approach is a detailed understanding of the blood supply to the femoral head, which takes its most important contribution from the deep branch of medial femoral circumflex artery (MFCA). In its extracapsular segment and as it travels superiorly, it crosses the tendon of obturator externus posteriorly and the conjoint tendon of gemellus inferior, obturator internus and gemellus superior anteriorly. Intact obturator externus is important surgically because it protects this branch from being stretched or disrupted during dislocation of the hip in any direction traumatically or surgically. Then, in intracapsular segment it runs along the posterosuperior aspect of the neck of the femur dividing into two to four superior retinacular vessels. The head can be completely perfused by the superior retinacular vessels alone without any other vascular input. The inferior retinacular, metaphyseal, lateral circumflex femoral and the artery of ligamentum teres contribute very little to the blood supply of head of femur. Surgical hip dislocation is technically demanding invasive procedure with high level of safety for femoral head perfusion. So meticulous execution of the surgical steps is important and it should be performed in tertiary care centers by surgeons with experience in hip preservation and with this technique specifically |