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Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography

Authors
 Chang Dong Han  ;  Young Han Lee  ;  Kyu Hyun Yang  ;  Ick Hwan Yang  ;  Woo Suk Lee  ;  Yoo Jung Park  ;  Jin Suk Suh  ;  Kwan Kyu Park 
Citation
 ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, Vol.133(3) : 361-366, 2013 
Journal Title
 ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 
ISSN
 0936-8051 
Issue Date
2013
MeSH
Aged ; Angiography ; Bone Nails/adverse effects ; Bone Screws/adverse effects* ; Female ; Femoral Artery/diagnostic imaging* ; Femoral Artery/injuries* ; Fracture Fixation, Intramedullary/adverse effects* ; Hip Fractures/surgery* ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Vascular System Injuries/etiology ; Vascular System Injuries/prevention & control*
Keywords
Femur ; Fracture ; Closed hip nailing ; Iatrogenic femoral artery injury
Abstract
BACKGROUND: Iatrogenic vascular injury as a result of closed hip nailing is not common, but is a regularly reported complication after hip fracture surgeries. METHODS: To prevent vascular injury in closed hip nailing by identifying the range of distances and angles between deep and superficial femoral arteries (DFAs and SFAs) and distal screws. PATIENTS AND METHODS: Forty subjects who underwent computed tomography angiographies were included in this study. Imaginary lines marking the distal screws (proximal femoral nail antirotation-II [PFNA-II], 180 and 300 mm; inter-trochanteric/sub-trochanteric nails [ITST], 200 and 300 mm) were drawn on the scout film. On arterial phase images, angles between distal screw lines and those marking DFAs or SFAs, as well as the distance between each artery and far cortex, were measured using the cross-reference capabilities of the picture archiving and communication system. RESULTS: The short nails (PFNA-II 200 mm and ITST 180 mm) were closest to the DFAs, indicating that these nails are most likely to cause injury (PFNA-II 200 mm: 11.2 ± 13.7° anterior and 9.87 ± 5.83 mm; ITST 180 mm: 22.56 ± 15.92° posterior and 9.24 ± 4.74 mm). The short nails were relatively distant from the SFAs, which were located posteriorly to the long nails (PFNA-II 300 mm and ITST 300 mm). CONCLUSIONS: These data indicate that insertion of distal screws into intramedullary nails increases the risk of injury to vascular structures. Surgeons must take care in drilling or inserting screws to ensure the prevention of vascular injury.
Full Text
http://link.springer.com/article/10.1007%2Fs00402-012-1674-5
DOI
10.1007/s00402-012-1674-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Kwan Kyu(박관규) ORCID logo https://orcid.org/0000-0003-0514-3257
Suh, Jin Suck(서진석) ORCID logo https://orcid.org/0000-0001-9455-9240
Yang, Kyu Hyun(양규현) ORCID logo https://orcid.org/0000-0001-7183-588X
Yang, Ick Hwan(양익환)
Lee, Young Han(이영한) ORCID logo https://orcid.org/0000-0002-5602-391X
Lee, Woo Suk(이우석) ORCID logo https://orcid.org/0000-0002-0798-1660
Han, Chang Dong(한창동)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86840
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