This cadaveric study of 24 hips maps the extracapsular and intracapsular course of the deep branch of the MFCA — the dominant blood supply to the femoral head. It defines topographic relationships to the external rotator tendons and tests vessel integrity during simulated surgical hip dislocation.
Every posterior hip approach carries the risk of AVN, yet for decades surgeons lacked a precise anatomical map of exactly where the deep branch of the MFCA runs relative to what they were cutting.
This paper gives you that map. When you approach the hip posteriorly, identify the trochanteric branch at the proximal border of quadratus femoris first — it is present in every patient and tells you exactly where the obturator externus tendon, and therefore the deep branch, will be.
Never divide the obturator externus tendon. When releasing the conjoint tendon, cut distal-to-proximal at least 1.5 cm from the trochanteric crest. These are not preferences. They are vascular imperatives backed by this anatomy.
The 31% AVN rate after operatively treated fracture-dislocation (versus 11% after non-operative simple dislocation) is the clinical cost of not following these principles. This paper is the anatomical foundation for the Ganz surgical hip dislocation, which achieves 360-degree femoral head access while keeping obturator externus. And the deep branch. Intact.
This cadaveric study of 24 hips maps the extracapsular and intracapsular course of the deep branch of the MFCA — the dominant blood supply to the femoral head. It defines topographic relationships to the external rotator tendons and tests vessel integrity during simulated surgical hip dislocation.
Every posterior hip approach carries the risk of AVN, yet for decades surgeons lacked a precise anatomical map of exactly where the deep branch of the MFCA runs relative to what they were cutting.
This paper gives you that map. When you approach the hip posteriorly, identify the trochanteric branch at the proximal border of quadratus femoris first — it is present in every patient and tells you exactly where the obturator externus tendon, and therefore the deep branch, will be.
Never divide the obturator externus tendon. When releasing the conjoint tendon, cut distal-to-proximal at least 1.5 cm from the trochanteric crest. These are not preferences. They are vascular imperatives backed by this anatomy.
The 31% AVN rate after operatively treated fracture-dislocation (versus 11% after non-operative simple dislocation) is the clinical cost of not following these principles. This paper is the anatomical foundation for the Ganz surgical hip dislocation, which achieves 360-degree femoral head access while keeping obturator externus. And the deep branch. Intact.