Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography

Chang Dong Han, Young Han Lee, Kyu Hyun Yang, Ick Hwan Yang, Woo Suk Lee, Yoo Jung Park, Jinsuck Suh, Kwan Kyu Park

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)361-366
Number of pages6
JournalArchives of Orthopaedic and Trauma Surgery
Volume133
Issue number3
DOIs
Publication statusPublished - 2013 Mar 1

Fingerprint

Femoral Artery
Nails
Hip
Vascular System Injuries
Thigh
Computed Tomography Angiography
Radiology Information Systems
Hip Fractures
Arteries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Han, Chang Dong ; Lee, Young Han ; Yang, Kyu Hyun ; Yang, Ick Hwan ; Lee, Woo Suk ; Park, Yoo Jung ; Suh, Jinsuck ; Park, Kwan Kyu. / Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography. In: Archives of Orthopaedic and Trauma Surgery. 2013 ; Vol. 133, No. 3. pp. 361-366.
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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.",
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Relationship between distal screws and femoral arteries in closed hip nailing on computed tomography angiography. / Han, Chang Dong; Lee, Young Han; Yang, Kyu Hyun; Yang, Ick Hwan; Lee, Woo Suk; Park, Yoo Jung; Suh, Jinsuck; Park, Kwan Kyu.

In: Archives of Orthopaedic and Trauma Surgery, Vol. 133, No. 3, 01.03.2013, p. 361-366.

Research output: Contribution to journalArticle

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AU - Lee, Young Han

AU - Yang, Kyu Hyun

AU - Yang, Ick Hwan

AU - Lee, Woo Suk

AU - Park, Yoo Jung

AU - Suh, Jinsuck

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N2 - 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.

AB - 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.

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