Femoral head perfusion in adults was studied by superselective i.a. DSA in 35 normal subjects, in 9 patients with medial femoral neck fracture preoperatively, and in 36 patients with femoral head necrosis before bone grafting, and as therapeutic control after grafting. All patients with femoral neck fracture showed an interruption of the proximal nutrient branches. In 93% of the cases with femoral head necrosis, these branches were rarefied or the medial circumflex femoral artery was interrupted. Postoperative DSA after pedicled pelvic bone graft revealed a regularly perfused graft in 82%. Superselective i.a. DSA is a valuable procedure for the therapeutic decision in selected patients with femoral neck fracture as well as before pedicled pelvic bone grafting and as therapeutic control after grafting.