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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
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.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86840
DOI
10.1007/s00402-012-1674-5
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실)
Yonsei Authors
박관규(Park, Kwan Kyu) ; 서진석(Suh, Jin Suck) ; 양규현(Yang, Kyu Hyun) ; 양익환(Yang, Ick Hwan) ; 이영한(Lee, Young Han) ; 이우석(Lee, Woo Suk) ; 한창동(Han, Chang Dong)
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Full Text
http://link.springer.com/article/10.1007%2Fs00402-012-1674-5
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