Fragments from the article: Phemister DB. Repair of bone in the presence of aseptic necrosis resulting from fractures, transplantations, and vascular obstruction (1930). The author discusses the involvement of the ligamentum capitis femoris (LCF) arteries in the blood supply and metaplasia of the femoral head. The text in Russian is available at the following link: 1930PhemisterDB.
Quotes.
The vessels of the ligamentum teres may supply
adequate blood to keep the head alive even in the aged.
…
If bony union occurs the head is gradually invaded by
the ingrowth of tissue from the distal fragment and sometimes from the
hypertrophied round ligament. The necrotic marrow is replaced by vascular
connective tissue and eventually by bone marrow, but the necrotic bone is much
more slowly absorbed and replaced by a variable amount of irregularly arranged
living bone.
…
If non-union results, the neck fragments are gradually
more or less completely eroded and the remaining surfaces usually become more
or less adherent to the capsule and to each other. The marrow spaces of the
dead and non-functioning head are gradually invaded by vascularized connective
tissue by way of the round ligament and in some cases by way of the adhesions.
Absorption of the invaded old bone and partial replacement by new bone either
does not take place at all, at least for many months, or it goes on very much
slower than is the case when bony union takes place and the head is subjected to
functional stimulation. The head casts a shadow for at least one to two years
that is denser than that of the neighboring living bone which is atrophic from
disuse. These points are illustrated by Fig. 7 showing a dense necrotic head
in a case of ununited fracture of the neck of the femur of sixteen months’
duration and by Fig. 8 which is a roentgenogram of a slice of the
excised head. Although both bone and marrow were dead and about one-half of the
marrow space was reinvaded by connective tissue from the round ligament, there
was no absorption of the dead bone except about the fovea, where there was also
a small amount of newly formed bone. Eventually absorption and partial
replacement of the dead head by new bone is brought about and the head may
remain as a cavitous hull or in rare cases it may be completely absorbed. The
bearing of these findings on prognosis and treatment are brought out in
Santos’s article.
…
Osteogenic elements of adjacent bone also participate
and more recent studies as those of Baschkirzew and Petrow [8], Leriche and Policard [9], and Kartaschew [10], indicate that fibrous tissue
invading aseptic bone may be gradually transformed into bone. That
this is not the source of any considerable amount of new bone replacing the
dead bone is shown by the observations of Santos that a necrotic head in
ununited fracture of the femoral neck is very little replaced by new bone by
metaplasia of invading connective tissue from the round ligament. If the
transplant is in the soft parts, disconnected with the skeleton and serving no
supporting function, the surviving unossified osteogenic elements about the
ends may proliferate temporarily, — as in the healing of a fracture of a bone
graft as shown by Haas, or in closing the open end of the medullary cavity of
the graft as shown by Phemister.
External links
Phemister
DB. Repair of bone in the presence of aseptic necrosis resulting from
fractures, transplantations, and vascular obstruction. J Bone Joint Surg
Am. 1930;12(4)769-87. journals.lww.com
Phemister DB.
The classic: repair of bone in the presence of aseptic necrosis resulting from
fractures, transplantations, and vascular obstruction. Clinical
orthopaedics and related research. 2008;466(5)1020-33. link.springer.com
Authors & Affiliations
Dallas Burton Phemister (1882-1951) was a professor and chairman of the Department of Surgery at
the University of Chicago, American surgeon and researcher. wikipedia.org
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur,
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