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

Abstract

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.

Electron microscopic and histological evaluation of structural components of the articular cartilage of the knee joint after multiple skeletal trauma

“…Надмірні навантаження на суглобові поверхні, як поодинокі (гострий вплив), так і повторювані (кумулятивне контактне напруження), можуть викликати зміни в суглобовому хрящі та розвиток остеоартозу як наслідок прямої травми на колінний суглоб [4]. Посттравматичний остеоартрит, як результат травми суглоба, викликає у багатьох мільйонів людей біль протягом усього життя і призводить до інвалідності [5][6][7][8][9][10].…”

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

“…Understanding the anatomical relationship between the femur and femoral artery along with its branches is critical in preventing iatrogenic vascular injuries. Sun et al showed that the femoral artery along the medial side of the femur, especially PFA and deep femoral artery, were at a higher risk of injury as they lay within 13 mm of bone [ 9 ]. The femoral artery on the medial side of the femur was at risk to screw insertion or overshooting with the drill.…”

Late deep femoral artery injury after intertrochanteric hip fracture treatment: A case report

“…A small part of these complications is related to the surgical procedure itself, as infection and loss of reduction. Vascular injuries are not common, but they are of great importance, because they may be potentially life or limb-threatening [ 1 , 2 ]. The deep femoral artery is the most commonly affected branch in the upper part of the femur (about 78.31 %).…”

“…Other possible factors that may also predispose to arterial injury are the use of an oversize perineal pole, excessive traction, or positioning the limb in adduction and internal rotation. This position forces the deep femoral artery and its branches to be near the medial aspect of the sub-trochanteric femur, making them vulnerable to injury by fracture fragments or screws [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ].…”