A 27-year-old man is brought to the emergency department by emergency medical services after a car accident. The patient was noted by the paramedics to have an alcoholic smell on his breath. The patient reports severe pain in his right hip and groin. Vital signs are significant for a blood pressure of 154/87 mmHg and a heart rate of 113 beats/minute. Physical examination reveals a deformity of his right hip. Laboratory tests are ordered and are pending. X-rays of the right hip show a posterior dislocation of the hip with associated femoral head fracture.
A) Common femoral artery
The majority of the blood supply to the head of the femur comes from the medial and lateral circumflex branches of the profunda femoris, which itself is a branch of the common femoral artery (the profunda femoris is the deep penetrating branch of the upper thigh).
Answer choice B: Inferior gluteal artery, is incorrect. The inferior gluteal artery forms an anastomosis with a branch of the femoral artery, but it is not the major arterial blood supply to the femur.
Answer choice C: Inferior mesenteric artery, is incorrect. This artery supplies the hindgut structures.
Answer choice D: Internal iliac artery, is incorrect. The obturator artery from the internal iliac artery is a minor blood supplier to the head of femur as compared to the profound femora.
Answer choice E: Pudendal artery, is incorrect. This artery supplies the pelvis organs, buttocks, and medial side of thighs.
Key Learning Point
The medial and lateral circumflex femoral arteries of the profunda femoris, which itself is a branch of the common femoral, anastomose around the neck of the femur to perfuse the femoral head. Another direct source of blood supply is from the foveal artery (also known as the artery of the ligamentum teres), though its contribution is only significant in pediatric populations. Two important anastomoses provide collateral blood flow (though limited) to support the femoral head. One is the cruciate anastomosis, which is between the inferior gluteal artery and the medial circumflex femoral artery. The other is the trochanteric anastomosis, which is between the superior gluteal artery and the medial and lateral circumflex femoral arteries. Both the superior and inferior gluteal arteries are branches off of the internal iliac artery (also known as the hypogastric artery).
