Femoral head epiphysis

Avascular necrosis of the femoral head and another of slipped capital femoral epiphysis with avascular necrosis have been reported in two children with growth hormone deficiency receiving growth hormone (74). 

The femoral head is uniquely vulnerable to vascular insult. The femoral head is two-thirds of a sphere which allows a large degree of movement in three planes. This large degree of movement afforded by the hip articulation is at the cost of a precarious blood supply. Apart from the ligamentum teres, there are no soft tissue attachments to the femoral head to enable arterial supply. Consequently, the blood supply to the femoral head is provided by the ligamentum teres and from generalised perfusion around the epiphysis. 

Perthes disease, also known as Legg-Calv -Perthes syndrome after the investigators who independently identified this condition in 1910, is related to an idiopathic avascular necrosis of the proximal femoral epiphysis. It mainly affects children 3-12 years old with a peak incidence at approximately 4-8 years and a definite prevalence (4 1) in males and lower social classes (Guille et al. 1998). The onset of Perthes disease is related to the development of the femoral head vasculature, which includes the ascending cervical arteries (branches from the medial and lateral circumflex arteries), the lateral epiphyseal vessels and... 

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