Vascular injuries complicating osteosynthesis in proximal femur fractures

Männer, M.; Rösch, B.; Roy, Kunal

doi:10.1007/s001130050395

Cited by 23 publications

(7 citation statements)

References 7 publications

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“…13,14 Manner et al emphasized that traction on a fracture table tightens the femoral muscles and additionally reduces the local mobility of the DFA. 15 Yang et al demonstrated the influence of the extremity’s position on the fracture table on the distances between femoral vessels and the medial femoral cortex. The mean distance between the SFA and the bone diminished significantly when the leg was brought into adduction of 20° on a traction table (reduction position) from 20.2 mm to 11.8 mm and even to 9.4 mm with an additional internal rotation of 20°, thus predisposing it to injury.…”

Section: Discussionmentioning

confidence: 99%

“…10 It is imperative to stay in close contact with the bone surface while passing the instrument and also to maintain the position of the dorsal half of the cerclage passer (Synthes) against the bone while bringing and engaging the ventral half to it. 9 Other precautionary measures could include reducing the amount of traction 15 as well as the amount of adduction and internal rotation 16 and also restricting the number of passes 4 in order to safeguard the vasculature during this procedure. We recommend strict vigilance for any undue bleeding particularly when the two halves of the cerclage passer (Synthes) are clamped together or when the two halves are disengaged and being removed.…”

Section: Discussionmentioning

confidence: 99%

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Vascular injuries due to cerclage passer: Relevant anatomy and note of caution

Devendra

Avinash

Chidambaram

et al. 2018

J Orthop Surg (Hong Kong)

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Purpose: The cerclage passer instrument was introduced for aiding percutaneous reduction in spiral femur fractures, thereby overcoming the risk of devascularization of the fracture ends commonly associated with traditional open cerclage wiring techniques. This may, however, predispose to iatrogenic vascular injuries owing to the proximity of the vessels and several other factors. We report four cases with femoral artery (superficial and deep) injuries caused by the cerclage passer in proximal femur and distal femur shaft fractures and incidence of these injuries in our institution. Methods: Retrospective analysis of hospital records of femoral fractures from 2011 to 2015. All cases of femoral fractures and periprosthetic femoral fractures with cerclage wiring done using the standard or the Synthes ® cerclage passer were included. Cases with wiring done for trochanteric fractures and other locations were excluded. Results: Incidence of vascular injuries due to the cerclage passer in proximal femur shaft fractures was 1.59%, whereas in distal femur shaft fractures it was 7.14%. There were two patients with a deep femoral artery (DFA) system injury and two with a superficial femoral artery (SFA) injury caused by the cerclage passer (Synthes) in two proximal femur shaft and two distal femur shaft fractures, respectively. End-to-end anastomosis for the SFA and ligation for DFA system injuries were used, with an uneventful postoperative period in all patients. Conclusion: Caution and accuracy is imperative to avoid vascular injuries while using the cerclage passer in femur fractures, and strict vigilance is essential for early identification and prompt management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vascular injuries due to cerclage passer: Relevant anatomy and note of caution

Devendra

Avinash

Chidambaram

et al. 2018

J Orthop Surg (Hong Kong)

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“…Contusions of the musculoskeletal system are among the commonest causes of emergency-room consultation. Vascular injury should be suspected in all patients with a history of trauma, including non-high-energy trauma, when haemodynamic instability appears [ 1 – 4 ]. At this point, additional studies need to focus on locating the affected area, and the patient should be admitted to intensive care to ensure that there is no deterioration of vital signs.…”

Section: Discussionmentioning

confidence: 99%

“…Acute vascular injuries have been described in relation to high-energy accidents in patients who are polytraumatised or undergoing surgery in the femoral area [ 1 – 4 ], but this diagnosis is very rare in young patients with no relevant medical history. In such cases, clinicians should be alert to the possibility of structural alterations in the vessels that predispose them to injury or impaired blood clotting [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Instability after Low-Energy Thigh Contusion Caused by Injury to the Femoral Artery: A Case Report and Literature Review

Rodríguez-Roiz

Ballesteros-Betancourt

García-Tarriño

et al. 2016

Case Reports in Orthopedics

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Acute vascular injuries have been described in relation to high-energy trauma accidents or in patients undergoing surgery in the femoral area. We describe a healthy patient who sustained a direct, low-energy contusion in the thigh and presented haemodynamic instability. Arteriography was used to locate the point of bleeding, and embolisation and vessel occlusion were carried out to stop the haemorrhage. The genetic study identified the COL3A1 gene mutation; accordingly, the patient was diagnosed with the Ehlers-Danlos syndrome type IV (vascular type).

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“… 7 Drill bit overpenetration can result in clinically relevant damage to nerves, tendons, and vessels, which negatively impact and complicate surgical outcomes. 8 9 10 , 11 , 12 13 …”

mentioning

confidence: 99%

Dual Motor Drill Continuously Measures Drilling Energy to Calculate Bone Density and Screw Pull-out Force in Real Time

Gilmer

Lang

2018

JAAOS Glob Res Rev

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Introduction:Low bone density complicates the surgical management of fractures. Screw stripping in osteoporotic bone leads to decreased fixation strength and weakening of the fixation construct. If low density could be detected during drilling, augmentation may be performed to prevent screw stripping. Furthermore, continuous monitoring of the drill bit depth and bone density can allow detection of the far cortex where density suddenly increases, providing immediate and accurate screw length measurement and reducing the risk of overpenetration or plunge in osteoporotic bone. Therefore, a dual motor drill was created to calculate bone density and pull-out force in real time. The purpose of this study was to determine whether real-time monitoring of drill bit torque and depth could be used to estimate bone density and pull-out force. We hypothesized that the calculated drilling energy could be used to determine density and would correlate with pull-out force.Methods:Drilling and screw insertion were performed using a validated composite unicortical bone model. Screws of 5-, 10-, and 20-mm length were placed into blocks of known densities (10, 20, 30, and 40 pounds per cubic foot). During creation of holes by the dual motor drill, drilling energy was recorded and used to calculate density. Calculated bone density was then compared with the known density of the block. The drill bit was exchanged for a screwdriver, and screw insertion energy was recorded in a similar fashion during screw placement. Screws were then subjected to maximal axial pull-out force testing with a material testing device. Recorded drilling energy and screw insertion energy were then correlated with the measured pull-out force.Results:Calculated bone density correlated very strongly with the known control density, confirming the accuracy of density calculations in real time. Drilling energy and screw insertion energy correlated very strongly with the measured pull-out force by destructive testing confirming ultimate pull-out force could be quantified during drilling or placement of a screw.Discussion:Our results confirmed that a dual motor drill can accurately and immediately allow determination of bone density and screw pull-out force before placing a screw. This knowledge could allow a surgeon to perform augmentation or alter surgical technique to prevent screw stripping and loss of fixation as well as detect the far cortex and prevent overpenetration in osteoporotic bone.

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Vascular injuries complicating osteosynthesis in proximal femur fractures

Cited by 23 publications

References 7 publications

Vascular injuries due to cerclage passer: Relevant anatomy and note of caution

Vascular injuries due to cerclage passer: Relevant anatomy and note of caution

Hemodynamic Instability after Low-Energy Thigh Contusion Caused by Injury to the Femoral Artery: A Case Report and Literature Review

Dual Motor Drill Continuously Measures Drilling Energy to Calculate Bone Density and Screw Pull-out Force in Real Time

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