Radiological assessment of the safe zone for medial minimally invasive plate osteosynthesis in the distal femur with computed tomography angiography

Kim, Jung Jae; Oh, Hyoung Keun; Bae, Joo-Yul; Kim, Ji Wan

doi:10.1016/j.injury.2014.09.023

Cited by 43 publications

(21 citation statements)

References 17 publications

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“…6,14,16,19,29 Minimally invasive plate osteosynthesis (MIPO) has widely been chosen as the treatment for shaft fractures of the long bones because it allows indirect fracture reduction and preservation of the blood supply to the fracture site. 11,25 However, indirect reduction of the clavicle is technically demanding due to the curved shape of the clavicle and the risk of iatrogenic neurovascular injury; thus, these MIPO procedures have not been frequently performed for midshaft clavicular fractures.…”

mentioning

confidence: 99%

Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating

Zhang

et al. 2016

Journal of Shoulder and Elbow Surgery

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mentioning

confidence: 99%

Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating

Zhang

et al. 2016

Journal of Shoulder and Elbow Surgery

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“…Although the medial approach is generally considered as rather demanding, a cadaveric study by Jiamton et al proved that the distal 60% of the femur are safe for MIPO. In another angiographic study, Kim et al concluded that anteromedial MIPO is safe up to 8 cm below the lesser trochanter.…”

Section: Discussionmentioning

confidence: 96%

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

Todorov

Zderic

Richards

et al. 2018

Journal Orthopaedic Research

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Treatment of complex osteoporotic distal femur fractures with the Less Invasive Stabilization System (LISS) has been associated with high complication rates. The aim of this study was to investigate the biomechanical competence of two different techniques of augmented versus conventional LISS plating. Unstable distal femoral fracture AO/OTA 33-A3 was created via osteotomies in artificial femora simulating osteoporotic bone. Three study groups, consisting of 10 specimens each, were created for fixation with either LISS plate, LISS plate with additional polylactide intramedullary graft, or LISS plate plus medial locking plate (double plating). All specimens were non-destructively tested under axial (20-150 N) and torsional (0-4 Nm) quasi-static loading. Each bone-implant construct was tested with two different working length (WL) configurations (long and short) of the LISS plate. Relative movements between the most medial superior and inferior osteotomy aspects were investigated via three-dimensional motion tracking analysis. Double plating revealed significantly smaller longitudinal and shear displacement than the other two techniques (p ≤ 0.001). In addition, LISS plus graft fixation was with significantly less longitudinal displacement in comparison to conventional LISS plating (p < 0.001). Long WL resulted in significantly higher longitudinal and shear displacement compared to short WL for LISS and LISS plus graft (p ≤ 0.032), but not for double plating (p > 0.999). In conclusion, intramedullary grafting resulted in significantly increased fracture stability under axial loading in comparison to conventional LISS plating. Although it was not efficient enough to provide comparable stability to double plating, intramedullary grafting may be considered as a useful biological alternative to the latter in a surgeon's armamentarium. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2604-2611, 2018.

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“…Besides, the outside-to-in screw insertion was not well considered, and the area of the femur associated with high risk of iatrogenic vascular injury was not analyzed. Kim et al [24] calculated the number of femoral arteries and average distance by regions from six levels, aiming to select a safe zone for minimally invasive medial plate fixation in the distal femur. The risky area was also not analyzed in particular in that study.…”

Section: Discussionmentioning

confidence: 99%

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

Sun

Fan

et al. 2017

Med Sci Monit

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BackgroundThis 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/MethodsIn 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.ResultsThere 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%).ConclusionsThe 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.

show abstract

Radiological assessment of the safe zone for medial minimally invasive plate osteosynthesis in the distal femur with computed tomography angiography

Cited by 43 publications

References 17 publications

Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating

Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

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

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