5. Blood Supply Hip Thigh Popliteal Fossa

Functional Anatomy of Lower Extremity: Blood Supply

• Blood supply to the hip, thigh, and popliteal fossa is complex, with multiple arteries providing critical oxygen and nutrient delivery to the region.
• Key arteries include the iliolumbar, lateral sacral, superior gluteal, inferior gluteal, internal pudendal arteries, internal iliac, external iliac, umbilical, obturator, superior vesical, and inferior vesical arteries.
• The femoral artery supplies the anterior and anteromedial thigh surface; it changes name to external iliac after crossing the inguinal ligament.
• The profunda femoral artery (deep femoral) arises from the femoral artery, near the inguinal ligament. This artery provides perforating branches through the add magnus, supplying the posterior thigh.
• The medial and lateral femoral circumflex arteries are crucial for supplying blood to the head and neck of the femur. They arise from either the profunda or femoral arteries.
• Retinacular arteries, arising from medial/lateral femoral circumflex arteries, are vital in supplying blood to the hip joint directly.
• A cruciate anastomosis is featured where multiple blood vessels (e.g., transverse branches of lateral circumflex artery, medial femoral circumflex artery, inferior gluteal artery, first perforating artery of profunda femoral artery) interconnect, providing a backup blood supply network in the hip area.
• Blood supply interruption can occur in cases of femoral neck fracture.
• Avascular necrosis or osteonecrosis can occur when blood supply to bone is disrupted, leading to bone death. Trauma or damage to the blood vessels may result in avascular necrosis.

Blood Supply in Popliteal Fossa

• The popliteal artery is a continuation of the femoral artery and extends to the superior border of the popliteus muscle.
• Branches of the popliteal artery include five genicular arteries: superior lateral, superior medial, inferior medial, inferior lateral, and middle genicular. They provide blood flow to the articular capsule and ligaments of the knee.
• Genicular anastomosis includes all genicular arteries (x5). It also includes descending genicular branches, descending branches of lateral femoral circumflex artery, and recurrent branches of anterior tibial artery.

Knee Anastomosis

• The knee joint's blood supply is provided by the genicular anastomosis.
• The genicular anastomosis comprises five genicular arteries: superior medial, superior lateral, middle, inferior medial, and inferior lateral genicular arteries.

Slips Capital Femoral Epiphysis (SCFE)

• SCFE is a condition where the femoral head slips away from the femoral neck, often due to weakened epiphyseal plate, microtrauma, shear stress.
• SCFE commonly occurs in children between ages 10 and 16. Boys are more prone to develop SCFE than girls.
• Overweight children are at increased risk of SCFE.
• Common treatments involve in-situ fixation (fixation of the bone in place by a single central screw) and possibly prophylactic bilateral surgical intervention when bilateral slip occurs.

Legg-Calvé-Perthes Disease

• Legg-Calvé-Perthes disease is a childhood avascular necrosis of the femoral head that is of unknown origin.
• It commonly affects boys between ages four and seven.
• Treatment historically involved casting or bracing, but evidence suggests that this approach does not differ from no treatment in regards to outcomes.