Osteonecrosis of the femoral head following medullary nailing of the femur in an adult.

The femoral head receives the majority of its blood supply via branches of the medial femoral circumflex artery, whose course runs across the piriformis fossa and along the superior aspect of the femoral neck. Cadaveric studies have demonstrated damage to the medial femoral circumflex artery in cases where the piriformis fossa was the entry point for intramedullary nailing. Although well recognised in children, osteonecrosis of the femoral head after intramedullary nailing has exceptionally been reported in adults. We present a case of osteonecrosis of the femoral head post-epiphyseal closure following IM nailing for a femoral fracture in a 22-year-old Caucasian adult.