Relationship Between Femur and Femoral Arteries for Identifying Risk Factors for Vascular Injury

Overview

Journal Med Sci Monit

Specialties General Medicine
Pathology

Date 2017 Apr 11

PMID 28392552

Citations 5

Authors

Qi Sun

Guoxin Fan

Xifan Li

Jinpeng Gong

Wei Ge

Ming Cai

Affiliations

Soon will be listed here.

Abstract

BACKGROUND This study aimed to identify risk factors for vascular injury in proximal femoral fracture through identifying frequency and distances between femur and femoral arteries with computed tomography angiography and 3-dimensional reconstruction. MATERIAL AND METHODS In a series of 400 participants, based on measurement results regarding the distribution of femoral arteries in the medial femur, the femoral portion covering that part was divided into levels A-E. The center region, margin region, and risky area in the medial femur were defined. The frequency of femoral arteries and interested shortest distance between the outer femur and superficial, deep, and perforating femoral arteries (SFAs, DFAs, and PFAs) in the center region, margin region, and risky area at each level were recorded. RESULTS There were 173 males and 227 females (average age: 63.61±19.18 years) in this study. The starting point and end point for femoral arteries in the medial femur were from 22.55±4.23% to 54.56±8.39% of the whole femur. The femoral arteries in the medial femur mainly were distributed at levels B (88.2%), C (65.9%), and D (40.6%). The femoral arteries in center regions in the risky area, most of which were DFAs and PFAs, were mainly concentrated at levels B (26.93%) and C (11.81%). CONCLUSIONS The mid-shaft level was the most risky level, and the DFAs and PFAs were easier to injure than the SFAs when performing internal fixation of proximal femoral fracture. We recommended that great attention be paid to drill and screw insertion around the mid-shaft level for prevention of iatrogenic vascular injury.

Citing Articles

A Case of Profunda Femoris Artery Pseudoaneurysm Treated With Catheterization and Surgical Hematoma Removal.

Kume N, Konagaya K, Okamoto T, Ogino H Cureus. 2023; 15(7):e42708.

PMID: 37654926 PMC: 10465818. DOI: 10.7759/cureus.42708.

Iatrogenic Injury to Profunda Femoris During a Dynamic Hip Screw Fixation for Intertrochanteric Fracture.

Lal A, Jesudason E, Gwyn R Cureus. 2023; 15(1):e33894.

PMID: 36819373 PMC: 9934907. DOI: 10.7759/cureus.33894.

Silent iatrogenic pseudoaneurysm after intertrochanteric fracture fixation with proximal femoral nailing and cerclage wiring: case report and review of literature.

Orapiriyakul W, Chewakidakarn C, Dissaneewate K, Dissaneewate P, Kritsaneephaiboon A Eur J Orthop Surg Traumatol. 2022; 33(6):2667-2681.

PMID: 36585997 DOI: 10.1007/s00590-022-03471-0.

Missed diagnosis of femoral deep artery rupture after femoral shaft fracture: A case report.

Ge J, Kong K, Cheng X, Li P, Hu X, Yang H World J Clin Cases. 2020; 8(13):2862-2869.

PMID: 32742996 PMC: 7360701. DOI: 10.12998/wjcc.v8.i13.2862.

Vascular Complications during Ilizarov Fixator Surgery to the Femur: Two Case Reports with the Introduction of a Method for Determining the Safe Vascular Corridor around the Femur.

Khanfour A, Khanfour A Strategies Trauma Limb Reconstr. 2020; 14(2):106-110.

PMID: 32742423 PMC: 7376588. DOI: 10.5005/jp-journals-10080-1434.

References

Ozkan K, Turkmen I, Sahin A, Yildiz Y, Erturk S, Soylemez M . A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: A study on synthetic bones. Indian J Orthop. 2015; 49(3):347-51. PMC: 4443419. DOI: 10.4103/0019-5413.156220. View

Okcu G, Ozkayin N, Erkan S, Tosyali H, Aktuglu K . Should full threaded compression screws be used in adult femoral neck fractures?. Injury. 2015; 46 Suppl 2:S24-8. DOI: 10.1016/j.injury.2015.05.028. View

Sahin E, Imerci A, Kinik H, Karapinar L, Canbek U, Savran A . Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. Eur J Orthop Surg Traumatol. 2013; 24(3):347-52. PMC: 3958814. DOI: 10.1007/s00590-013-1195-0. View

Haubro M, Stougaard C, Torfing T, Overgaard S . Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur. Injury. 2015; 46(8):1557-61. DOI: 10.1016/j.injury.2015.05.006. View

Naouli H, Jiber H, Bouarhroum A . False aneurysm of perforating branch of the deep femoral artery-Report of two cases. Int J Surg Case Rep. 2015; 14:36-9. PMC: 4573209. DOI: 10.1016/j.ijscr.2015.07.001. View

Handolin L, Pajarinen J, Tulikoura I . Injury to the deep femoral artery during proximal locking of a distal femoral nail--a report of 2 cases. Acta Orthop Scand. 2003; 74(1):111-3. DOI: 10.1080/00016470310013789 . View

Lazarov M, VAN DER Bracht H, Victor J, Stuyts B . Missed diagnosis of false aneurysm of the superficial femoral artery after closed complex fracture of the distal femur. Orthop Traumatol Surg Res. 2014; 100(6):695-7. DOI: 10.1016/j.otsr.2014.04.005. View

Kickuth R, Anderson S, Kocovic L, Ludwig K, Siebenrock K, Triller J . Endovascular treatment of arterial injury as an uncommon complication after orthopedic surgery. J Vasc Interv Radiol. 2006; 17(5):791-9. DOI: 10.1097/01.RVI.0000217929.35607.15. View

Ma K, Wang X, Luan F, Xu H, Fang Y, Min J . Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res. 2014; 100(8):859-66. DOI: 10.1016/j.otsr.2014.07.023. View

10.

Bartonicek J . [Injuries to femoral vessels in fractures of the hip]. Rozhl Chir. 2009; 88(4):203-5. View

11.

Barquet A, Gelink A, Giannoudis P . Proximal femoral fractures and vascular injuries in adults: Incidence, aetiology and outcomes. Injury. 2015; 46(12):2297-313. DOI: 10.1016/j.injury.2015.10.021. View

12.

Yang K, Park H, Park S . Pseudoaneurysm of the superficial femoral artery after closed hip nailing with a Gamma nail: report of a case. J Orthop Trauma. 2002; 16(2):124-7. DOI: 10.1097/00005131-200202000-00009. View

13.

Yang K, Yoon C, Park H, Won J, Park S . Position of the superficial femoral artery in closed hip nailing. Arch Orthop Trauma Surg. 2004; 124(3):169-72. DOI: 10.1007/s00402-003-0618-5. View

14.

Canbaz S, Acipayam M, Gurbuz H, Duran E . False aneurysm of perforating branch of the profunda femoris artery after external fixation for a complicated femur fracture. J Cardiovasc Surg (Torino). 2002; 43(4):519-21. View

15.

Kim J, Oh H, Bae J, Kim J . Radiological assessment of the safe zone for medial minimally invasive plate osteosynthesis in the distal femur with computed tomography angiography. Injury. 2014; 45(12):1964-9. DOI: 10.1016/j.injury.2014.09.023. View

16.

Rajaesparan K, Amin A, Arora S, Walton N . Pseudoaneurysm of a branch of the profunda femoris artery following distal locking of an intramedullary hip nail: an unusual anatomical location. Hip Int. 2008; 18(3):231-5. DOI: 10.1177/112070000801800308. View

17.

Han C, Han Lee Y, Yang K, Yang I, Lee W, Park Y . Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography. Arch Orthop Trauma Surg. 2012; 133(3):361-6. DOI: 10.1007/s00402-012-1674-5. View

18.

Patelis N, Koutsoumpelis A, Papoutsis K, Kouvelos G, Vergadis C, Mourikis A . Iatrogenic injury of profunda femoris artery branches after intertrochanteric hip screw fixation for intertrochanteric femoral fracture: a case report and literature review. Case Rep Vasc Med. 2014; 2014:694235. PMC: 3971853. DOI: 10.1155/2014/694235. View

19.

Laohapoonrungsee A, Sirirungruangsarn Y, Arpornchayanon O . Pseudoaneurysm of profunda femoris artery following internal fixation of intertrochanteric fracture: two cases report. J Med Assoc Thai. 2006; 88(11):1703-6. View

20.

Muller F, Galler M, Zellner M, Bauml C, Fuchtmeier B . The fate of proximal femoral fractures in the 10th decade of life: an analysis of 117 consecutive patients. Injury. 2015; 46(10):1983-7. DOI: 10.1016/j.injury.2015.06.048. View