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Conditions of the Hip Quiz
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Which artery is most at risk of injury in a displaced intracapsular neck of femur fracture, leading to avascular necrosis of the femoral head?
- A Inferior gluteal artery You picked ✕
- B Deep femoral artery You picked ✕
- C Medial femoral circumflex artery You picked ✓
- D Lateral femoral circumflex artery You picked ✕
- E Obturator artery You picked ✕
Correct!
Incorrect
The answer is C: Medial femoral circumflex artery
Explanation
Why C is correct
See Neck of femur fracture. Option C is correct. The neck of the femur is the narrow part joining the rounded head to the shaft. A fracture here is intracapsular if it lies inside the capsule (the fibrous bag that surrounds the hip joint). These fractures are commoner in older women with osteoporosis (thin, fragile bone) and the leg usually looks shortened, adducted and externally rotated. The medial circumflex femoral artery provides the main arterial supply to the femoral head in adults, and its branches run along the neck inside the capsule. A displaced intracapsular fracture can tear or kink these vessels, so the head loses its blood supply and dies: this is avascular necrosis. That is why the blood supply matters so much and why treatment of a displaced intracapsular fracture in older people often involves a full or partial hip replacement. Extracapsular fractures lie outside the capsule, beyond the origin of these vessels, so avascular necrosis is very rare in them.
- Fracture site: an intracapsular neck of femur fracture lies inside the hip capsule.
- Artery: the medial circumflex femoral artery gives the main blood supply to the femoral head in adults.
- Complication: damage to its branches causes avascular necrosis of the femoral head.
Why the other options are incorrect
- A. Inferior gluteal artery: The inferior gluteal artery supplies the gluteal region and muscles around the hip, not the femoral head. It is not the artery at risk in an intracapsular fracture. Your answer
- B. Deep femoral artery: The deep femoral artery gives rise to the circumflex arteries but lies in the thigh below the fracture site. The vessel injured at the femoral neck is its circumflex branch, not the parent artery. Your answer
- D. Lateral femoral circumflex artery: The lateral circumflex femoral artery contributes less to the femoral head and has to penetrate the thick iliofemoral ligament to reach it. Damage to it is not the main cause of avascular necrosis after a neck fracture. Your answer
- E. Obturator artery: The obturator artery gives a small branch to the head through the ligament of the head of the femur in many people, but it is not the main supply in adults. It is not the vessel at risk in a neck fracture. Your answer
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1
Which of the following is the most appropriate first-line management for osteoarthritis of the hip?
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2
A 24-year-old man is brought to the emergency department after a high-speed car collision in which his right knee struck the dashboard. His right leg is flexed, adducted and internally rotated at the hip. Which nerve injury is most likely to be associated with this presentation?
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