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Risk of extrapelvine vascular injuries in osteosynthesis with gliding hip screws

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Dynamic hip screw (DHS) osteosynthesis represents one of the most frequently performed fixation methods in orthopedic practice. The purpose of this study was to determine the potential risk of vascular damage by DHS side-plate screws (PS) and plunging instruments for individual femoral vessels and screw positions.

Methods

In ten hemipelvic/leg specimens mounted with a large femur distractor, a DHS system with a four-hole side-plate was inserted. PS were inserted in 3 consecutive courses with different inclinations in the frontal plane of 0° (group 1), − 30° posterior (group 2) and + 30° anterior (group 3) in relation to the side-plate’s surface, resulting in 120 PS positions. After screw tightening, the soft tissues on the medial side of the femur were dissected and investigated for vascular compromise; in each course, the effect of overshot instruments within a range of 50 mm beyond the side-plate’s surface was also tested.

Results

Totally, 37/120 screw positions (31%) revealed potential vascular compromise which comprised of 15/120 (13%) direct hits by screw tips and 22/120 (18%) potential impacts by plunging instruments. The deep femoral artery system (DFA) was significantly (p = 0.007) most often affected but no significant differences for individual vascular structures were seen. Direct vascular impacts occurred significantly more often (p = 0.0047) in screws with 0° inclination compared to + 30° inclination (p = 0.017). Significant differences among individual screw positions were only found in group − 30° with direct vessel contacts (p = 0.038).

Conclusions

The DFA system is significantly more at risk while significant preference of a certain vessel is missing. Our data indicate that more than 30% of 120 screw positions in DHS osteosynthesis revealed a potential danger of vascular compromise, when surgical principles are denied in hip fracture fixation.

Clinical relevance

Though vascular complications are infrequently encountered in DHS osteosynthesis they have to be considered as a potential complication when surgical principles are not followed in this anatomic area.

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References

  1. Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD (2008) Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures. J Am Acad Orthop Surg 16(11):665–673

    Article  PubMed  Google Scholar 

  2. Abraham E, Pankovich AM, Jansey F (1975) False aneurysm of the profunda femoris artery resulting from intertrochanteric fracture. A case report. J Bone Jt Surg 57(6):871

    Article  CAS  Google Scholar 

  3. Yang KH, Yoon CS, Park HW, Won JH, Park SJ (2004) Position of the superficial femoral artery in closed hip nailing. Arch Orthop Trauma Surg 124(3):169–172. https://doi.org/10.1007/s00402-003-0618-5

    Article  PubMed  Google Scholar 

  4. O’Donoghue D, Muddu BN, Woodyer AB, Kumar R (1994) False aneurysm of the profunda femoris artery due to malunion of a hip fracture. Injury 25(10):681–682

    Article  PubMed  Google Scholar 

  5. Soballe K, Christensen F (1987) Laceration of the superficial femoral artery by an intertrochanteric fracture fragment. A case report. J Bone Jt Surg 69(5):781–783

    Article  CAS  Google Scholar 

  6. Yang KH, Park HW, Park SJ (2002) Pseudoaneurysm of the superficial femoral artery after closed hip nailing with a Gamma nail: report of a case. J Orthop Trauma 16(2):124–127

    Article  PubMed  Google Scholar 

  7. Neubauer T, Grechenig S, Leitner L, Auffarth A, Plecko M (2016) Vascular complications in plating of the proximal femur: review. Arch Orthop Trauma Surg 136(4):539–551. https://doi.org/10.1007/s00402-015-2406-4

    Article  PubMed  Google Scholar 

  8. Eggert A, Huland H (1974) Vascular injuries during osteosynthesis in the proximal femoral shaft. Zentralbl Chir 99(30):946–950

    CAS  PubMed  Google Scholar 

  9. Entwisle JJ, De Nunzio M, Hinwood D (2001) Case report: transcatheter embolization of pseudoaneurysm of the profunda femoris artery complicating fracture of the femoral neck. Clin Radiol 56(5):424–427. https://doi.org/10.1053/crad.1999.0286

    Article  CAS  PubMed  Google Scholar 

  10. Karanikas I, Lazarides M, Arvanitis D, Papayanopoulos G, Exarchou E, Dayantas J (1993) Iatrogenic arterial trauma associated with hip fracture surgery. Acta Chir Belg 93(6):284–286

    CAS  PubMed  Google Scholar 

  11. Barquet A, Gelink A, Giannoudis PV (2015) Proximal femoral fractures and vascular injuries in adults: incidence, aetiology and outcomes. Injury 46(12):2297–2313. https://doi.org/10.1016/j.injury.2015.10.021

    Article  PubMed  Google Scholar 

  12. Garrido-Gomez J, Garrido-Gomez MN, Arrabal-Polo MA, Garrido-Pareja F, Linares-Palomino JP (2012) Iatrogenic false aneurysms. A rare complication of hip surgery. Hip Int J Clin Exp Res Hip Pathol Ther 22(4):397–402. https://doi.org/10.5301/HIP.2012.9338

    Article  Google Scholar 

  13. Manner M, Rosch B, Roy K (1999) Vascular injuries complicating osteosynthesis in proximal femur fractures. Unfallchirurg 102(3):227–231

    Article  CAS  PubMed  Google Scholar 

  14. Murphy PG, Geoghegan JG, Austin O, More-O’Ferrall R, Quinlan WR, Keaveny TV (1999) Pseudoaneurysm of the profunda femoris artery due to intertrochanteric fracture of the hip. Arch Orthop Trauma Surg 119(1–2):117–118

    Article  CAS  PubMed  Google Scholar 

  15. Ritchie ED, Haverkamp D, Schiphorst TJ, Bosscha K (2007) False aneurysm of the profunda femoris artery, a rare complication of a proximal femoral fracture. Acta Orthop Belg 73(4):530–532

    PubMed  Google Scholar 

  16. Lazarides MK, Arvanitis DP, Dayantas JN (1991) Iatrogenic arterial trauma associated with hip joint surgery: an overview. Eur J Vasc Surg 5(5):549–556

    Article  CAS  Google Scholar 

  17. Wolfgang GL, Barnes WT, Hendricks GL Jr (1974) False aneurysm of the profunda femoris artery resulting from nail-plate fixation of intertrochanteric fracture. A case report and review of the literature. Clin Orthop Relat Res 100:143–150

    Article  Google Scholar 

  18. Aylward C, Acosta A, Bennett L, Nattfogel E, Johnson I, Pusey R (2006) Potential damage to the profunda femoris artery during dynamic hip screw (DHS) fixation. Clin Anat 19(8):769

    Article  Google Scholar 

  19. Wilson JS, Miranda A, Johnson BL, Shames ML, Back MR, Bandyk DF (2003) Vascular injuries associated with elective orthopedic procedures. Ann Vasc Surg 17(6):641–644. https://doi.org/10.1007/s10016-003-0074-2

    Article  PubMed  Google Scholar 

  20. Tiwary SK, Kumar S, Khanna R, Khanna AK (2007) Iatrogenic femoral artery aneurysms in orthopaedic practice. ANZ J Surg 77(10):899–901. https://doi.org/10.1111/j.1445-2197.2007.04269.x

    Article  PubMed  Google Scholar 

  21. Laohapoonrungsee ASY, Arpornchayanon O (2005) Pseudoaneurysm of profunda femoris artery following internal fixation of intertrochanteric fracture: two cases report. J Med Assoc Thail 88(11):1703–1706

    Google Scholar 

  22. Grimaldi M, Courvoisier A, Tonetti J, Vouaillat H, Merloz P (2009) Superficial femoral artery injury resulting from intertrochanteric hip fracture fixation by a locked intramedullary nail. Orthop Traumatol Surg Res 95(5):380–382. https://doi.org/10.1016/j.otsr.2009.04.014

    Article  CAS  PubMed  Google Scholar 

  23. Lee J, Niranjan NS (2008) Pelvic girdle, gluteal region and thigh, 1329–1386. In: Standring S (ed) Gray’s anatomy: the anatomical basis of clinical practise, vol 40. Churchill Livingstone, Elsevier, ‎London

    Google Scholar 

  24. Davda K, Pollard TC, Graham AJ (2009) Delayed presentation of lateral femoral circumflex artery injury post cannulated hip screw surgery—a case report. Ann R Coll Surg Engl 91(4):W3–W5. https://doi.org/10.1308/147870809X401001

    Article  PubMed  PubMed Central  Google Scholar 

  25. Alajmo G, Schlegel U, Gueorguiev B, Matthys R, Gautier E (2012) Plunging when drilling: effect of using blunt drill bits. J Orthop Trauma 26(8):482–487. https://doi.org/10.1097/BOT.0b013e3182336ec3

    Article  PubMed  Google Scholar 

  26. Clement H, Heidari N, Grechenig W, Weinberg AM, Pichler W (2012) Drilling, not a benign procedure: laboratory simulation of true drilling depth. Injury 43(6):950–952. https://doi.org/10.1016/j.injury.2011.11.017

    Article  PubMed  Google Scholar 

  27. Toursarkissian B, Allen BT, Petrinec D, Thompson RW, 416 Rubin BG, Reilly JM, Anderson CB, Flye MW, Sicard GA (1997) Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. J Vasc Surg 25(5):803–808 (discussion 808–809)

    Article  CAS  PubMed  Google Scholar 

  28. Asmus F (2002) The dynamic hip screw: standard implant for fractures of the proximal femur. Analysis of 6615 documented cases of the Arbeitsgemeinschaft für Osteosynthesefragen. Personal communication under guidance of AO International (Matter P) and AO ASIF ducumentation center (Bühler M)

  29. Ryzewicz M, Robinson M, McConnell J, Lindeque B (2006) Vascular injury during fixation of an intertrochanteric hip fracture in a patient with severe atherosclerosis. A case report. J Bone Jt Surg 88(11):2483–2486. https://doi.org/10.2106/JBJS.F.00389

    Article  Google Scholar 

  30. Ebong WW (1978) False aneurysm of the profunda femoris artery following internal fixation of an intertrochanteric femoral fracture. Injury 9:249–251

    Article  CAS  PubMed  Google Scholar 

  31. Kleintz R, Nolte U (1993) Development of aneurysma spurium of the arteria profunda femoris as a late complication of DHS osteosynthesis. Unfallchirurg 96(1):39–40

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma Surgery, Federal Hospital Horn, Spitalgasse 10, 3850, Horn, Austria

    Thomas Neubauer

  2. Institute of Anatomy, Karl Franzens University Graz, Harrachgasse 21, 8010, Graz, Austria

    St. Grechenig

  3. Department of Orthopaedics, Karl Franzens University Graz, Auenbruggerplatz 5, 8036, Graz, Austria

    L. Leitner

  4. Trauma Hospital Graz, Göstinger Straße 24, 8020, Graz, Austria

    H. Clement & M. Plecko

  5. Department of Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria

    A. Auffarth

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  1. Thomas Neubauer
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  2. St. Grechenig
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Correspondence to Thomas Neubauer.

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Neubauer, T., Grechenig, S., Clement, H. et al. Risk of extrapelvine vascular injuries in osteosynthesis with gliding hip screws. Arch Orthop Trauma Surg 139, 339–345 (2019). https://doi.org/10.1007/s00402-018-3077-8

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  • DOI: https://doi.org/10.1007/s00402-018-3077-8

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