The Blood Supply of the Femoral Neck and Head in Relation to the Damaging Effects of Nails and Screws

Failures in the treatment of fractures of the femoral neck are caused by several factors. Some of these, such as avascular necrosis of the femoral head, cannot be avoided. Other factors, such as inaccurate reduction or imperfect fixation, can be partly controlled. The possibility has long been considered that the nail itself and the disturbance caused by its introduction might damage the blood vessels of the femoral head. Cedermark ( 1936) suspected this, and later the studies of Trueta and Harrison (1953) provided the anatomical basis for the clinical suspicions of Watson-Jones (1955) and Hulth (1956) that the nail might damage the vessels of the upper part of the head. In the present work an attempt has been made to determine how the nail or screws may damage the vessels of the femoral head and how the danger may be reduced by correct placing of the fixing agent.