title: Vascular complications in plating of the proximal femur: review.
abstract: BACKGROUND
  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.
  
  
  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.
authors.affiliation: Department of Trauma Surgery, Federal Hospital Horn, Spitalgasse 10, 3850, Horn, Austria/EU. thneubauer@aon.at.
authors.forename: Th
authors.initials: T
authors.lastname: Neubauer
authors.affiliation: Institute of Anatomy, Karl Franzens University Graz, Harrachgasse 21, 8010, Graz, Austria/EU.
authors.forename: St
authors.initials: S
authors.lastname: Grechenig
authors.affiliation: Department of Trauma Surgery, Federal Hospital Horn, Spitalgasse 10, 3850, Horn, Austria/EU.
authors.forename: L
authors.initials: L
authors.lastname: Leitner
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria/EU.
authors.forename: A
authors.initials: A
authors.lastname: Auffarth
authors.affiliation: Trauma Hospital Graz, Göstinger Straße 24, 8020, Graz, Austria/EU.|Division of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, Ch-8091, Zurich, Switzerland/Europe.
authors.forename: M
authors.initials: M
authors.lastname: Plecko
mesh_terms: D001860:Bone Plates / Q000009:adverse effects*; D005263:Femoral Artery / Q000293:injuries*; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D057772:Vascular System Injuries / Q000209:etiology*
keywords: Hip surgery; Plate osteosynthesis; Proximal femur; Vascular complication