Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-04-2016 | Trauma Surgery

Vascular complications in plating of the proximal femur: review

Authors: Th. Neubauer, St. Grechenig, L. Leitner, A. Auffarth, M. Plecko

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2016

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.

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

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):681–682CrossRefPubMed

Klinger HM, Baums MH, Eckert M, Neugebauer R (2005) A comparative study of unstable per- and intertrochanteric femoral fractures treated with dynamic hip screw (DHS) and trochanteric butt-press plate vs. proximal femoral nail (PFN). Zentralbl Chir 130(4):301–306. doi:10.1055/s-2005-836784 CrossRefPubMed

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

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. doi:10.1007/s00402-003-0618-5 CrossRefPubMed

Dameron TB Jr (1964) False aneurysm of femoral profundus artery resulting from internal-fixation device (Screw). J Bone Joint Surg Am 46:577–580PubMed

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

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. doi:10.1053/crad.1999.0286 CrossRefPubMed

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):124–127CrossRefPubMed

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):284–286PubMed

11.

Canbaz S, Acipayam M, Gurbuz H, Duran E (2002) False aneurysm of perforating branch of the profunda femoris artery after external fixation for a complicated femur fracture. J Cardiovasc Surg (Torino) 43(4):519–521

12.

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 Joint Surg Am 88(11):2483–2486. doi:10.2106/JBJS.F.00389

13.

Bassett FH, Houck WS (1964) False aneurysm of the profunda femoris artery after subtrochanteric osteotomy and nail-plate fixation. J Bone Joint Surg Am 46:583–585PubMed

14.

Meyer TL, Slager RF (1964) False Aneurysm Following Subtrochanteric Osteotomy. The Journal of bone and joint surgery American 46:581–582

15.

Nachbur B, Meyer RP, Verkkala K, Zurcher R (1979) The mechanisms of severe arterial injury in surgery of the hip joint. Clin Orthop Relat Res 141:122–133PubMed

16.

Anderson OG, Brookes JA, Cobb J (2005) False aneurysm caused by failed fracture fixation. Hosp Med 66(7):422–423. doi:10.12968/hmed.2005.66.7.18389 CrossRefPubMed

17.

Chan WS, Kong SW, Sun KW, Tsang PK, Chow HL (2010) Pseudoaneurysm and intramuscular haematoma after dynamic hip screw fixation for intertrochanteric femoral fracture: a case report. J Orthop Surg (Hong Kong) 18(2):244–247

18.

Cowley A, Williams D, Butler M, Edwards A, Parsons S (2007) Pseudo-aneurysm of the profunda femoris artery as a late complication of hip fracture in a patient with myelodysplasia. Ann R Coll Surg Engl 89(7):W4–6. doi:10.1308/147870807X238221 CrossRefPubMedPubMedCentral

19.

Hamoui M, Larbi A, Bommart S, Faure P, Largey A, Canovas F (2010) False aneurysm of the perforating branch of the profunda femoris artery following intertrochanteric fracture, a rare vascular complication: clinical, radiological features and management: case report and review of the literature. Euro J Orthop Surg Traumatol Orthop Traumatol 20:59–65CrossRef

20.

Jiya TUB, Bruijninckx MMM, Slis HW, deRooij TPW, deRidder VA (2000) False aneurysm of the profunda artery complicating dynamic hip screw osteosynthesis. Eur J Trauma 26(5):261–263CrossRef

21.

Karkos CD, Hughes R, Prasad V, D’Souza SP (1999) Thigh compartment syndrome as a result of a false aneurysm of the profunda femoris artery complicating fixation of an intertrochanteric fracture. J Trauma 47(2):393–395CrossRefPubMed

22.

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

23.

Laohapoonrungsee A, Sirirungruangsarn Y, Arpornchayanon O (2005) Pseudoaneurysm of profunda femoris artery following internal fixation of intertrochanteric fracture: two cases report. J Med Assoc Thai 88(11):1703–1706PubMed

24.

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

25.

Mauerhan DR, Maurer RC, Effeney D (1981) Profunda femoris arterial laceration secondary to intertrochanteric hip fracture fragments: a case report. Clin Orthop Relat Res 161:215–219PubMed

26.

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):117–118CrossRefPubMed

27.

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):530–532PubMed

28.

Whitehill R, Wang GJ, Edwards JR, Stamp WG (1978) Late injuries to femoral vessels after fracture of the hip. Case report. J Bone Joint Surg Am 60(4):541–542

29.

Craxford S, Gale M, Lammin K (2013) Arterial injury to the profunda femoris artery following internal fixation of a neck of femur fracture with a compression hip screw. Case Reports Orthoped 2013:181293. doi:10.1155/2013/181293

30.

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 Experim Res Hip Pathol Therapy 22(4):397–402. doi:10.5301/HIP.2012.9338

31.

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

32.

Hoffmann R, Schmidmaier G, Schulz R, Schutz M, Sudkamp NP (1999) Classic nail versus DHS. A prospective randomised study of fixation of trochanteric femur fractures. Der Unfallchirurg 102(3):182–190CrossRefPubMed

33.

Mundi S, Pindiprolu B, Simunovic N, Bhandari M (2014) Similar mortality rates in hip fracture patients over the past 31 years. Acta orthopaedica 85(1):54–59. doi:10.3109/17453674.2013.878831 CrossRefPubMedPubMedCentral

34.

Fordyce A (1968) False aneurysm of the profunda femoris artery following nail and plate fixation of an intertrochanteric fracture. Report of a case. J Bone Joint Surg Br 50(1):141–143

35.

Jindal R, Dhanjil S, Carrol T, Wolfe JH (2004) Percutaneous thrombin injection treatment of a profunda femoris pseudoaneurysm after femoral neck fracture. J Vascul Int Radiol JVIR 15(11):1335–1336. doi:10.1097/01.RVI.0000138670.06985.F5 CrossRef

36.

Shah YR, Nagammanavar S, Syed TA, Zafar F, Wetherill MH (2008) Pseudoaneurysm of the profunda femoris artery: a rare complication of intertrochanteric fracture fixation. Euro J Orthop Surg Traumatol Orthop Traumatol 18(8):591–593CrossRef

37.

Bansal RLP (2006) Iatrogenic blunt arterial injury during a hip fracture surgery. Acta Orthop Belg 72(1):96–99PubMed

38.

Maravic MLBC, Landais P, Fardellone P (2001) Incidence and cost of osteoporotic fractures in France during, a methodological approach by the national hospital database. Osteoporosis Int 16(12):1475–1480CrossRef

39.

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):665–673CrossRefPubMed

40.

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. doi:10.1007/s10016-003-0074-2 CrossRefPubMed

41.

Bernstein I, Geks J, Walthers EM, Schnabel M (2004) False aneurysm and bleeding caused by a secondary dislocated lesser trochanter fragment. Der Unfallchirurg 107(12):1192–1195. doi:10.1007/s00113-004-0791-1 CrossRefPubMed

42.

Lohmann H, Esenwein S, Geier B, Vogel T, Kleinert H (2009) False aneurysm of the deep femoral artery due to pertrochanteric fracture of the hip with displaced fragment of the lesser trochanter. Zeitschrift fur Orthopadie und Unfallchirurgie 147(1):23–25. doi:10.1055/s-2008-1039115 PubMed

43.

Keel JD, Eyres KS (1993) Vascular injury by an intertrochanteric fracture fragment. Injury 24(5):350–352CrossRefPubMed

44.

Bergqvist D, Erikson U, Grevsten S (1972) False aneurysm in the deep femoral artery as a complication of osteosynthesis of intertrochanteric femoral fracture. Report of a case. Acta chirurgica Scandinavica 138(6):630–632PubMed

45.

Ebong WW (1978) False aneurysm of the profunda femoris artery following internal fixation of an intertrochanteric femoral fracture. Injury 9(3):249–251CrossRefPubMed

46.

Muhlrad J (1979) Selective arterial embolization for hemorrhage following hip fracture fixation. Mount Sinai J Med N Y 46(4):412–415

47.

Mackenzie DBGN, Van Rensburg MNJ (1983) False aneurysm of the profunda femoris artery as a late complication of upper femoral osteotomy. S Afr J Surg 21(4):255–261PubMed

48.

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):W3–5. doi:10.1308/147870809X401001 CrossRefPubMedPubMedCentral

49.

Standring S (2008) The anatomical basis of clinical practice. In: Gray’s Anatomy. 40th edn. Churchill Livingstone Elesevier, pp 1332–1385

50.

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 100:143–150CrossRefPubMed

51.

Pradhan DJ, Juanteguy JM, Wilder RJ, Michelson E (1972) Arterial injuries of the extremities associated with fractures. Arch Surg 105(4):582–585CrossRefPubMed

52.

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

53.

Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, Anderson CB, Flye MW, Sicard GA (1997) Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. Journal of vascular surgery 25 (5):803-808; discussion 808-809

54.

Singh S, Arora S, Thora A, Mohan R, Sural S, Dhal A (2013) Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture. Chinese journal of traumatology = Zhonghua chuang shang za zhi/Chinese Medical Association 16(4):233–236

55.

Wang C (1975) False aneurysm of the profundus femoral artery following nail-plate fixation for intertrochanteric fracture of the hip. J Med Soc New Jersey 72(7):623–624PubMed

56.

Lewin JR (1966) The arteriographic diagnosis of a pseudoaneurysm of the femoral artery resulting from an orthopedic device. Vasc Dis 3(5):332–334PubMed

57.

Ahlgren SA, Eklof B (1981) Femur fracture and false aneurysm. Acta chirurgica Scandinavica 147(5):377–379PubMed

58.

Hanna GB, Holdsworth RJ, McCollum PT (1994) Profunda femoris artery pseudoaneurysm following orthopaedic procedures. Injury 25(7):477–479CrossRefPubMed

59.

Ahmad F, Turner SA, Torrie P, Gibson M (2008) Iatrogenic femoral artery pseudoaneurysms—a review of current methods of diagnosis and treatment. Clin Radiol 63(12):1310–1316. doi:10.1016/j.crad.2008.07.001 CrossRefPubMed

60.

Lee SS, Ueng SW, Shih CH (1999) Aneurysm-induced intertrochanteric bone loss reconstructed by a vascularized iliac graft: case report. J Trauma 46(5):944–947CrossRefPubMed

61.

Tzeng WS, Wu RH, Chang JM, Lin CY, Koay LB, Uen YH, Tian YF, Fong Y (2005) Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery. J Gastroenterol Hepatol 20(7):1062–1068. doi:10.1111/j.1440-1746.2005.03768.x CrossRefPubMed

62.

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

63.

Moss GD, Chmell S, Pillars JR Jr, Haid S, Milewski S (1985) Femoral artery laceration complicating an intertrochanteric hip fracture: a multi-disciplinary therapeutic problem. Orthopedics 8(12):1511–1513PubMed

64.

Sclafani SJ, Shaftan GW (1982) Transcatheter treatment of injuries to the profunda femoris artery. AJR Am J Roentgenol 138(3):463–466. doi:10.2214/ajr.138.3.463 CrossRefPubMed

65.

Stanton PE Jr, Rosenthal D, Clark M, Lamis P (1985) Percutaneous transcatheter embolization of injuries to the profunda femoris artery: a case report. Angiology 36(9):650–655CrossRefPubMed

66.

Horton RE (1972) Arterial injuries complicating orthopaedic surgery. J Bone Joint Surg Br 54(2):323–327PubMed

67.

Aufranc OE, Jones WN, Stewart WG Jr (1965) common fracture with unusual associated vascular injury. JAMA 191:1073–1075CrossRefPubMed

68.

Saletta JD, Freeark RJ (1972) Injuries to the profunda femoris artery. J Trauma 12(9):778–785CrossRefPubMed

Title: Vascular complications in plating of the proximal femur: review
Authors: Th. Neubauer
St. Grechenig
L. Leitner
A. Auffarth
M. Plecko
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2406-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Vascular complications in plating of the proximal femur: review

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2016

Patient rated outcomes study into the surgical interventions available for the rheumatoid hand and wrist

Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate

Can graft choice affect return to sport following revision anterior cruciate ligament reconstruction surgery?

Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope

Conventional over-the-top-aiming devices with short offset fail to hit the center of the human femoral ACL footprint in medial portal technique, whereas medial-portal-aiming devices with larger offset hit the center reliably

Two-stage revision arthroplasty for periprosthetic joint infections: What is the value of cultures and white cell count in synovial fluid and CRP in serum before second stage reimplantation?