The vascular supply of the femoral head is unique in that its vessels travel along the length of the femoral neck between the bone and the inelastic capsule, reinforced by the iliopsoas muscle. During their course, these vessels are exposed to trauma and to pressure. The high intra-articular pressure created in the hip joint during certain maneuvers and in the positions used in standard treatment suggests that, both in fractures and in certain diseases of the hip, an intra-articular tamponade may obstruct the vascular supply of the head.
Consistent clinical and experimental findings have been presented which appear to verify this hypothesis. Practical application of the results of this study would point to the need for aspiration of the hip or fenestration of the capsule during the treatment of intra-articular fractures. Also, avoidance of traction in certain positions during the preoperative and the postoperative periods should be considered. The phenomenon described also argues against immobilization of the hip in extension when there is an excessive amount of synovial fluid, as is found in certain acute conditions and injuries in children.