Highlights
- •Safe Zone for drilling at time of fixation of intertrochanteric fractures.
- •Reducing morbidity and mortality in patients with proximal femoral fractures.
- •Identification of the relation between the profunda femoris artery and the medial femoral cortex.
- •Distal screws on the dynamic hip screw side plate are the dangerous screws and excessive care should be practiced while drilling them.
Abstract
Objectives
Iatrogenic injury of the Profunda Femoris Artery (PFA) at time of hip fixation surgery
can increase morbidity and mortality and prolong the hospital stay. This is an injury
that tends to pass unnoticed as a cause of postoperative deterioration despite being
frequently reported in the literature. Our study aims to describe the anatomy of the
PFA in relation to the medial femoral cortex with specific emphasis on its orientation
relative to the position of a sliding hip screw side plate construct. By doing so
we are able to present clear guidance to orthopaedic surgeons on how to avoid iatrogenic
PFA injury at the time of hip fracture fixation.
Methods
Using Computed Tomography Angiographic (CTA) studies, the course of the PFA in relation
to the medial femoral cortex was traced in 44 patients (28 males and 16 females) with
mean age of 65.6 years. Coronal and axial CT sections were cross-linked to specify
the position of the PFA at 1 cm intervals.
Results
The course of the artery could be divided into three parts relative to a fixed reference
point. Proximal and distal parts of the artery were in a safer position in comparison
to the middle part of the artery that was found very close to the femoral cortex and
along the coronal axis of the femur (mean angle 2.9° from the femoral coronal axis
and 13.8 mm from the medial femoral cortex). Using the commercially available side
plate constructs, this part of the artery corresponded to the distal part of the plate
(third and fourth holes).
Conclusion
Special attention needs to be practiced by the operating surgeon while drilling into
the third and fourth holes of the side plate.
Keywords
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Article info
Publication history
Published online: January 14, 2019
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Crown Copyright © 2019 Published by Elsevier Ltd. All rights reserved.
