title: Relationship Between Femur and Femoral Arteries for Identifying Risk Factors for Vascular Injury.
abstract: BACKGROUND This study aimed to identify risk factors for vascular injury in proximal femoral fracture through identifying frequency and distances between femur and femoral arteries with computed tomography angiography and 3-dimensional reconstruction. MATERIAL AND METHODS In a series of 400 participants, based on measurement results regarding the distribution of femoral arteries in the medial femur, the femoral portion covering that part was divided into levels A-E. The center region, margin region, and risky area in the medial femur were defined. The frequency of femoral arteries and interested shortest distance between the outer femur and superficial, deep, and perforating femoral arteries (SFAs, DFAs, and PFAs) in the center region, margin region, and risky area at each level were recorded. RESULTS There were 173 males and 227 females (average age: 63.61±19.18 years) in this study. The starting point and end point for femoral arteries in the medial femur were from 22.55±4.23% to 54.56±8.39% of the whole femur. The femoral arteries in the medial femur mainly were distributed at levels B (88.2%), C (65.9%), and D (40.6%). The femoral arteries in center regions in the risky area, most of which were DFAs and PFAs, were mainly concentrated at levels B (26.93%) and C (11.81%). CONCLUSIONS The mid-shaft level was the most risky level, and the DFAs and PFAs were easier to injure than the SFAs when performing internal fixation of proximal femoral fracture. We recommended that great attention be paid to drill and screw insertion around the mid-shaft level for prevention of iatrogenic vascular injury.
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland).
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland).
authors.forename: GuoXin
authors.initials: G
authors.lastname: Fan
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland).
authors.forename: XiFan
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland).
authors.forename: JinPeng
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland).
authors.forename: Wei
authors.initials: W
authors.lastname: Ge
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland).
authors.forename: Ming
authors.initials: M
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D003198:Computer Simulation; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D057772:Vascular System Injuries / Q000601:surgery