Question
An 80-year-old woman is brought to the emergency department for left hip pain 30 minutes after she fell while walking around in her room. Examination shows left groin tenderness. The range of motion of the left hip is limited because of pain. An x-ray of the hip shows a linear fracture of the left femoral neck with slight posterior displacement of the femur. Which of the following arteries was most likely damaged in the patient’s fall?
| A. |
Deep circumflex iliac artery
|
| B. |
Medial circumflex femoral artery
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| C. |
Lateral femoral circumflex artery
|
| D. |
Deep femoral artery
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Show Answer
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Correct Answer � B
Explanation
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Answer B) Medial circumflex femoral
Explanation:The artery that courses posterior to the femoral neck is at greatest risk of injury in this case. Damage to this artery can cause avascular necrosis of the femoral head.
Medial circumflex femoral artery
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The medial circumflex femoral artery is a major branch of the profunda femoris. It courses medio posteriorly to the neck of the femur, where it supplies blood to the head and neck of the femur.
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A minority of femoral neck fractures will go on to develop osteonecrosis of the femoral head stemming from injuries to this artery and its small branches to the bone.
Lateral femoral circumflex
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The lateral circumflex femoral artery arises from the profunda femoris distal to the greater trochanter.
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This structure supplies blood to muscles of the anterior and lateral compartments of the thigh and is at risk in femoral shaft or intertrochanteric fractures.
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Although they are small, variable branches off of the lateral femoral circumflex can supply a minority of the femoral head’s blood supply.
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However, this vessel is unlikely to have been damaged in this patient with posterior displacement because of its location anterior to the femoral head.
Deep femoral artery
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The deep femoral artery, also known as the profunda femoris, is one of two major divisions of the femoral artery (the other being the superficial femoral artery).
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It typically branches off the femoral artery near the greater trochanter, distal to the site of a femoral neck fracture.
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Rarely, open reduction and internal fixation of a femoral neck fracture may lead to injury of this vessel, but this patient’s fracture in itself would be unlikely to pose a risk.
Deep circumflex iliac
Because of its intrapelvic course, it is not at risk in cases of femoral neck fractures.
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