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Risk of Arterial Injury During Hip Internal Fixation
Rizwan Jaipurwala1, Michael Galea1, Andrew Hardidge1
1Orthopaedics Department (R.J. and A.H.) and Radiology Department (M.G.), Austin Hospital, Heidelberg, Victoria, Australia.
Insights
Internal hip fixation risks femoral artery injury. Two arteries lie near the medial femoral shaft, requiring careful screw placement to prevent vascular damage during hip fracture surgery.
Area of Science:
- Orthopaedic Surgery
- Vascular Anatomy
- Medical Imaging
Background:
- Internal fixation of the hip carries a risk of injury to femoral arterial vessels.
- Understanding the anatomy of medial vessels, which are not directly visualized, is crucial for reducing complications.
Purpose of the Study:
- To analyze the precise location of medial femoral arteries relative to the planned screw trajectory in hip fracture fixation.
- To provide anatomical data to help surgeons avoid vascular injury during proximal femoral fracture fixation procedures.
Main Methods:
- Computed tomographic (CT) angiograms of the lower limbs from 47 patients were analyzed.
- Distances from the greater trochanter to the profunda femoris artery and its perforators near the medial femoral shaft were measured.
- Measurements were taken along the expected placement of dynamic hip screw constructs.
Main Results:
- All patients had two perforator vessels within 5 mm of the medial femoral shaft along the dynamic hip screw insertion line.
- The first perforator was located at a mean distance of 112.6 mm (women) and 123.4 mm (men) from the greater trochanter.
- The second perforator was located at a mean distance of 159.7 mm (women) and 178.9 mm (men) from the greater trochanter.
Conclusions:
- Surgeons must be aware of two arteries within 5 mm of the medial femoral shaft during hip fixation.
- Avoid overdrilling the medial cortex and using screws that are too long (110-130 mm from the greater trochanter) to prevent vascular injury.
- This anatomical understanding aids surgical planning and may reduce vascular complications in hip fracture fixation.
Background:
Injury to femoral arterial vessels is a risk with internal fixation of the hip. Understanding the anatomy of proximate vessels, particularly medial vessels not directly visualized, may reduce intraoperative and postoperative complications.
Methods:
We analyzed 47 patients (29 men and 18 women) using a computed tomographic (CT) angiogram of the lower limbs. The mean age of our patients was 69 years (range, 46 to 88 years). The distance from the tip of the greater trochanter to the profunda femoris and its perforators within 5 mm of the medial femoral shaft was measured along the length of the expected placement of typical dynamic hip screw constructs and other proximal femoral fracture fixation methods.
Results:
All patients were found to have 2 perforator vessels within 5 mm of the medial femoral shaft along the line of dynamic hip screw insertion (up to 200 mm from the tip of the greater trochanter). The first perforator was found at a mean distance of 112.6 mm (median, 110 mm) in women and at 123.4 mm (median, 122 mm) in men (p = 0.0066) from the tip of the greater trochanter. The second perforator appeared at a mean distance of 159.7 mm (median, 159 mm) in women and 178.9 mm (median, 180 mm) in men (p = 0.0028) from the tip of the greater trochanter.
Conclusions:
Surgeons should be aware of the presence of 2 arteries within 5 mm of the medial femoral shaft during femoral internal fixation procedures. We suggest avoiding the overdrilling of the medial cortex and the insertion of overlong screws along the femoral shaft from 110 to 120 mm in women and 120 to 130 mm in men (as measured from the tip of the greater trochanter) to prevent vascular injury during proximal femoral fracture fixation.
Clinical Relevance:
This article can assist orthopaedic surgeons in planning for procedures involving internal fixation of the hip and may reduce vascular complications from such procedures.
