[Vascularization of the trochanter fragment after digastric trochanterotomy in man]. / Vascularisation du fragment trochantérique après la trochantérotomie digastrique chez l'homme.

We examined the human vascular anatomy to the greater trochanter after digastric trochanterotomy, using some injection techniques and practiced the trochanterotomy (digastric, classic). We found 3 major sources of blood supply to the greater trochanter: the proximal soft tissues, including the gluteus medius and minimus, were mainly vascularized from the internal iliac artery system, and the distal soft tissues, including the vastus lateralis, were vascularized from the branches of the lateral circumflex femoral artery (LCFA). A third possible source of blood circulation came from the LCFA, but this branch was only found in 12 to 15 samples. Many vascular structures from the LCFA were concentrated in the anterior half of the vastus lateralis muscle which were deeply imbedded and ran upward to the trochanteric insertion of the vastus lateralis muscle. The distance from the superior tip of the greater trochanter to the point at which the first branch of the descending branch of the LCFA enters into the vastus lateralis muscles was from 65 mm. to 125 mm. The descending branch was found consistently in all 20 samples. Our results proved that with digastric trochanterotomy, we can preserve all three sources of vascularization whereas with classic trochanterotomy the supply from the transverse and descending branches of the LCFA are lost.

Blood supply of the greater trochanter after trochanterotomy.

The human vascular anatomy to the greater trochanter after a trochanterotomy (digastric, standard) was examined using injection techniques. Three major sources of blood supply to the greater trochanter were found: the proximal soft tissues, including the gluteus medius and minimus vascularized mainly from the internal iliac artery system; the distal soft tissues, including the vastus lateralis, vascularized from the descending branches of the lateral circumflex femoral artery; and a third possible source of blood circulation came from the transverse branch of the lateral circumflex femoral artery. Many vascular structures from the lateral circumflex femoral artery were concentrated in the anterior half of the vastus lateralis muscle. Perfusion with a latex oxide mixture and angiography after trochanterotomy proves that by using a digastric trochanterotomy, the transverse and descending branches of the lateral circumflex femoral artery to the greater trochanter thus can be preserved. With a standard trochanterotomy, the supply from the transverse and descending branches of the lateral circumflex artery are lost. These results therefore suggest that a digastric trochanterotomy is superior to a standard trochanterotomy because the blood supply of the trochanter is preserved.

Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis.

An anatomical and biomechanical study of the stabilizing ligaments of the thumb trapeziometacarpal joint was conducted on 32 hand specimens. Five main ligamentous structures could be identified. The mechanical properties (in particular, strength) of the five ligaments using a strain-rate failure test were determined and evaluated quantitatively. The maximum tensile strength of each ligament was correlated with the condition of the trapeziometacarpal articular cartilage. In studying the anterior oblique ligament, maximum strength decreased from Grade 0 to Grade 1 by 51%. With the first intermetacarpal ligament, the drop from Grade 1 to Grade 2 was 53%. With the posterior oblique ligament, the decrease was closely related to the grade of the deterioration of the trapeziometacarpal articular surface. These three ligaments also significantly decreased in strength with age. Our results may suggest that the anterior oblique ligament, intermetacarpal ligament and posterior oblique ligament play a large role in stabilizing the trapeziometacarpal joint and that the decrease in their strength is related to the pathogenesis of trapeziometacarpal osteoarthritis.