Iatrogenic Vascular Injury During Reduction of Femoral Neck Fractures: A Cadaveric Study

The femoral head's blood supply, primarily provided by the medial circumflex femoral artery (MCFA), is vulnerable to mechanical interruptions caused by traumatic or iatrogenic events. Disruption of this blood flow is associated with an inherent risk of avascular necrosis (AVN), which significantly impairs the surgical outcomes. This study aimed to evaluate the impact of using the Bennett retractor on femoral head vascular integrity during simulated fracture reductions.

A descriptive cadaveric study was conducted on 10 specimens to assess vascular injury induced by the Bennett retractor. Methylene blue dye angiography was performed to visualize perfusion patterns after retractor application. The MCFA perfusion disruption was documented. The effect of MCFA location and anatomical variations in this disruption was also investigated. No statistical analysis was performed due to the small sample size and descriptive nature of the study.

Vascular disruption was observed in 9 out of 10 cadaveric specimens (90%), as demonstrated by reduced MCFA perfusion in angiographic evaluation. In 1 case without MCFA compromise, the MCFA was located along the medial border of the femoral neck. Anatomical variations in the MCFA's origin (90% profunda femoris, 10% femoral artery) and position were noted, although these variations did not influence the incidence of injury incidence.

The Bennett retractor poses a significant risk of iatrogenic MCFA injury during femoral neck fracture reduction, emphasizing the need for alternative techniques or devices to minimize vascular compromise. Further research is required to explore the clinical implications of anatomical variations and develop strategies to mitigate AVN risk.