The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation.

Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN.

Cite this article: Bone Joint J 2013;95-B:1453–7.

The aim of the study: The authors are going to compare three treatment methods of ring pelvic fractures: operative, non-operative and with the use of an external fixator.

Material and methods: Between 1995 and 2005, 395 patients with pelvic ring fractures were treated at our department. 131 patients took part in this study. There were 84 (64,1%) males and 47 (35,9%) females. The common reason of the injury were car accidents 98 patients (74,8%), the second were falls 23 (17,5%), crush 7 (5,4%) and others 3 (2,3%). All patients were initially evaluated with use of three standard plain radiographs (anterioposterior radiograph, inlet and outlet projection according Penal & Tile) and computerized tomography scans and three-dimensional reconstructions of the scans. These studies were used to classify the fractures according to the classification of Young-Burgess. There were LC I 24, LC II 30, LC III 2, APC I 8, APC II 22, APC III 8, VS 10, CMI 27 fractures. 39 patients (29,8%) were treated no operatively, 48 patients (36,6%) were treated with use of the external fixator, 18 (13,7%) patients were treated by combination of open reduction and fixation with additional external fixation, and the rest of patients (26, 19,9%) were treated by open reduction and fixation.

Results: The clinical results were evaluated according to the Majeed scale. Long term clinical results were for individual type of fractures: LC I- 14 excellent, 6 good, 4 fair, 0 poor;

LC II- 11 excellent, 6 good, 8 fair, 5 poor; LC III- 0 excellent, 2 good, 0 fair, 0 poor;

Conclusion: A comparison of the non-operative and operative methods showed that anatomical open reduction and fixation gave the shortest time of treatment and better clinical results. The anatomical reduction and fixation the posterior parts of the pelvic is the key to good long term clinical result of treatment.