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Archives of Orthopaedic and Trauma Surgery

, Volume 136, Issue 4, pp 539–551 | Cite as

Vascular complications in plating of the proximal femur: review

  • Th. Neubauer
  • St. Grechenig
  • L. Leitner
  • A. Auffarth
  • M. Plecko
Trauma Surgery

Abstract

Introduction

Plating of the proximal femur represents a standard fixation method in orthopedic and trauma surgery. Vascular lesions are uncommon but potentially life-threatening. With the increasing number of hip surgery also more of these complications have to be anticipated. The purpose of this study was to evaluate the most common types and locations of vascular lesions after plating of the proximal femur as well as the most important causes.

Materials and methods

A literature research was undertaken of the English and german literature on vascular complications after plating of the proximal femur following a structured search protocol.

Results

62 cases with vascular compromise after plating of the proximal femur revealed significantly more iatrogenic origin (n = 41/62) was observed than lesions caused by fracture fragments (n = 11/62) (p = 0.0001); most iatrogenic reasons (n = 28/62) were related to the insertion of plate screws (PS). Lesions were significantly more often located (57/62) in the deep femoral artery (DFA) system than in other vascular systems (n = 5/62) (p = 0.0001). Vascular damages represented significantly more often pseudoaneurysms (PA) (42/62) than major lesions in the vessel wall with acute bleeding (17/62) or vascular occlusions (3/62); (p = 0.0001). PA cases also revealed a significantly longer diagnostic delay than other lesions (36 days vs. 2 days, p = 0.0064). Among clinical symptoms swelling of the thigh (57/62), local pains (42/62) and anemia (26/62) were most often observed. Swelling and pains were significantly more often reported in PAs (p = 0.0338; p = 0.0003). Most patients achieved full functional recovery (n = 41/62), but over-all complication rate was quite high (n = 18/62).

Conclusions

Vascular compromise in plate osteosynthesis of the proximal femur affects significantly more often the DFA system and represents most often PA. As the majority of cases revealed iatrogenic origin, a thorough surgical technique and awareness can help to avoid these complications.

Keywords

Proximal femur Plate osteosynthesis Vascular complication Hip surgery 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Th. Neubauer
    • 1
  • St. Grechenig
    • 2
  • L. Leitner
    • 1
  • A. Auffarth
    • 5
  • M. Plecko
    • 3
    • 4
  1. 1.Department of Trauma SurgeryFederal Hospital HornHornAustria/EU
  2. 2.Institute of AnatomyKarl Franzens University GrazGrazAustria/EU
  3. 3.Trauma Hospital GrazGrazAustria/EU
  4. 4.Division of Trauma SurgeryUniversity Hospital ZurichZurichSwitzerland/Europe
  5. 5.Department of Traumatology and Sports InjuriesParacelsus Medical University SalzburgSalzburgAustria/EU

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