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I have had one hip injury that almost cost me my leg. After fracturing the neck of my femur, I lost the blood supply to the head of the femur. Now I've gone and torn the labrum on the other side. Will the same problem develop now? I am going to have surgery to repair the damage.

Fractures of the upper portion of the femur (thigh bone) that disrupt the blood supply to the femoral head can cause a problem called osteonecrosis (bone death). It sounds like that might be what happened to you with the hip fracture. A labral tear is a different sort of injury altogether (i.e., different from hip fractures). The labrum is a thick rim of fibrous cartilage around the edge of the hip acetabulum (socket). It is there to increase the depth of the hip socket. The labrum also provides a seal to help protect the hip articular (joint surface) cartilage. Until recently, very little was really known about the blood supply to this area. But now, thanks to orthopedic surgeons from the Iran University of Medical Sciences we have a better understanding of the location and pattern of the blood vessels to, in, and around the labru. These surgeons teamed up with researchers from the Department of Anatomy at the Legal Medicine Research Center in Tehran (Iran) to perform this study. They examined the hips of 35 cadavers (hips preserved after death for study). They used a special colored silicone that was injected into the blood vessels around the hip labrum. The donor hips came from 28 cadavers ranging in age (at the time of death) from 20 to 50 years old. Cause of death was unknown but there was no damage to the hips and no signs of previous surgeries to the area. Twenty-four hours after the silicon injections, they carefully took the hips apart and examined the blood vessels (now clearly visible from the injected dye). They found the beginning point (source) of the blood supply to the labrum and followed it to its insertion site into the hip joint capsule. For the first time ever, the vascular ring pattern around the labrum is clearly seen. This structure has been given the name: periacetabular vascular ring. Peri- means "around" and acetabular refers to the hip socket. Seven of the hips had a visible labral tear. All specimens came from males. The presence of these labral injuries made it possible for the researchers to answer another big question. Is the blood supply to the labrum disrupted when the labrum is injured? In all seven cases, the answer was No. The periacetabular ring was fully intact despite damage to the labrum. Osteonecrosis is not a typical problem after labral repairs. But you might feel better if you bring up your concerns with the orthopedic surgeon and hear what he or she might have to say about this worry. It appears that if the loose connective tissue containing the vascular ring is not disrupted, then no damage is done to the labrum's vascular supply. Every effort should be made to avoid damaging the periacetabular vascular ring. Labral repair with preservation of this capsular-sided connective tissue will enhance healing.


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