Abstract

OBJECTIVES: To describe the inferior retinacular artery (IRA) as encountered from an anterior approach, to define its intra-articular position and to define a safe zone for buttress plate fixation of femoral neck fractures.METHODS: Thirty hips (15 fresh cadavers) were dissected via an anterior (Modified Smith-Petersen) approach following common femoral artery injection (India ink, blue latex). The origin of the IRA from the medial femoral circumflex artery (MFCA) and the course to its terminus were dissected. The IRA position relative to the femoral neck was described using a clock face system: 12:00 cephalad, 3:00 anterior, 6:00 caudad, 9:00 posterior.RESULTS: The IRA originated from the MFCA and traveled within Weitbrecht's ligament in all hips. The IRA positions were 7:00 (n=13), 7:30 (n=15), and 8:00 (n=2). The IRA was 0:30 anterior to (n=24) or at the same clock face position (n=6) as the lesser trochanter. The mean intra-articular length was 20.4 mm (range 11 to 65, SD 9.1), and the mean extra-articular length was 20.5 mm (range 12 to 31, SD 5.1).CONCLUSIONS: The intra-articular course of the IRA lies within Weitbrecht's ligament between the femoral neck clock face positions of 7:00 and 8:00. A medial buttress plate positioned at 6:00 along the femoral neck is anterior to the location of the IRA and does not endanger the blood supply of the femoral head. The improved understanding of the IRA course will facilitate preservation during intra-articular approaches to the femoral neck and head.

View details for PubMedID 30562252