Exploration of the Superior Retinacular Arterial System of the Femoral Head after Femoral Neck Fractures in Young Adults

Abstract

There are no well-accepted criteria for the treatment of femoral neck fractures in young adults. Currently, the main goal of the treatment is to preserve the native hip joint. Femoral neck fractures in young adults are often caused by severe injuries and manifested as displaced fractures (Garden stage III or IV fractures), in which certain injuries of the posterior–superior retinaculum in the femoral head and neck can easily cause distortion, traction, compression, and even rupture of the superior or/and inferior retinacular arteries (SRA and IRA), which are the main arteries that supply the femoral head. Consequently, secondary avascular necrosis of the femoral head may occur. Preoperative and intraoperative evaluation of the blood supply to the femoral head is of great significance for the treatment selection and prognosis. Preoperatively, super-selective digital subtraction angiography (DSA) can be used to objectively determine the blood supply of the retinacular arteries (SRA and IRA) to the femoral head. However, DSA cannot clearly distinguish the specific causes of blood supply interruption (such as distortion, traction, compression, and rupture). It is necessary to consider whether to explore the retinacular vessels during surgery according to the specific fracture type to monitor and restore the blood supply under direct vision.