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Pasquinelly A, Andrews K. Profunda Femoris Pseudoaneurysm and Fatal Hemorrhage 2 Weeks After Modified Girdlestone Resection Arthroplasty: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00019. [PMID: 38271544 DOI: 10.2106/jbjs.cc.23.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CASE A 62-year-old nonambulatory female patient presented with wound dehiscence and purulent bloody drainage 2 weeks after modified Girdlestone resection arthroplasty for subtrochanteric femur fracture. On developing an enlarging thigh hematoma and hemodynamic instability, the patient was taken to the vascular suite where a profunda femoris artery pseudoaneurysm was identified and ligated by the vascular surgery team. The proximal free edge of the resected femur was determined to be the likely cause of arterial injury. Two days later, the patient was taken by the orthopaedic surgery team for debridement and revision resection arthroplasty, but she ultimately decompensated and died. CONCLUSION We believe this to be the first reported case of this serious complication of the Girdlestone procedure. We hope this case helps bring awareness to the complication and aids in early detection and prompt treatment of femoral artery complications.
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Affiliation(s)
- Adam Pasquinelly
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Kyle Andrews
- Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
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Wang W, Long Y, Liu C, Qi Y. Delayed deep femoral artery injury concomitant with femoral vein thrombosis after hip fracture. Asian J Surg 2024; 47:846-847. [PMID: 37926611 DOI: 10.1016/j.asjsur.2023.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Wen Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, No.16766, Jingshi Road, Jinan, Shandong Province, China.
| | - Yuntao Long
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, No.16766, Jingshi Road, Jinan, Shandong Province, China.
| | - Chenghui Liu
- Department of Orthopedic Surgery, Jinan Seventh People's Hospital, No. 21 Gongye North Road, Jinan, Shandong Province, China.
| | - Yubin Qi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, No.16766, Jingshi Road, Jinan, Shandong Province, China.
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Arnold MCA, Zhao S, Doyle RJ, Jeffers JRT, Boughton OR. Power-Tool Use in Orthopaedic Surgery: Iatrogenic Injury, Its Detection, and Technological Advances: A Systematic Review. JB JS Open Access 2021; 6:JBJSOA-D-21-00013. [PMID: 34841185 PMCID: PMC8613350 DOI: 10.2106/jbjs.oa.21.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Power tools are an integral part of orthopaedic surgery but have the capacity to cause iatrogenic injury. With this systematic review, we aimed to investigate the prevalence of iatrogenic injury due to the use of power tools in orthopaedic surgery and to discuss the current methods that can be used to reduce injury.
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Affiliation(s)
| | - Sarah Zhao
- The MSk Lab, Imperial College London, London, United Kingdom
| | - Ruben J Doyle
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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Buruian A, Silva Gomes F, Roseiro T, Vale C, Carvalho A, Seiça E, Mendes A, Pereira C. Distal interlocking for short trochanteric nails: static, dynamic or no locking? Review of the literature and decision algorithm. EFORT Open Rev 2020; 5:421-429. [PMID: 32818069 PMCID: PMC7407850 DOI: 10.1302/2058-5241.5.190045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pertrochanteric hip fractures are among the most common and the use of short cephalomedullary nails as the treatment of choice is increasing. A systematic review regarding distal locking options for short cephalomedullary nails was undertaken using Medline/PubMed®, Embase® and Cochrane Library® in order to evaluate current indications, associated complications and to provide treatment recommendations. The results seem to support the use of distal static locking for unstable fractures, dynamic locking for length stable/rotational unstable fractures and no locking for stable fractures. Complications associated with distal locking include iatrogenic fractures, thigh pain, delayed union and nonunion, implant failure, screw loosening and breaking, drill bit breaking, soft tissue irritation, femoral artery branch injury, intramuscular haematoma and compartment syndrome. It is also associated with longer operative time and radiation exposure. In unlocked constructs, dorsomedial comminution and nail/medullary canal mismatch contribute to peri-implant fractures. Anterior cortical impingement is associated with cut-out and nonunion. Most studies comparing distally locked and unlocked nails report a short follow-up. Distal locking mode should be based on the fracture’s stability.
Cite this article: EFORT Open Rev 2020;5:421-429. DOI: 10.1302/2058-5241.5.190045
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Affiliation(s)
- Alexei Buruian
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | | | - Tiago Roseiro
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Claudia Vale
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - André Carvalho
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Emanuel Seiça
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Antonio Mendes
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
| | - Carlos Pereira
- Hospital Distrital da Figueira da Foz, Figueira Da Foz, Portugal
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Asadollahi S, Holcdorf D, Stella DL, Bucknill A. Identification of the lateral femoral safe zone for drilling during LISS plate fixation of distal femur fractures. Injury 2020; 51:452-456. [PMID: 31882235 DOI: 10.1016/j.injury.2019.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of arterial injury associated with femoral fractures is approximately 1%. Lateral sub-muscular plate fixation is gaining popularity for the management of distal femoral fractures. The objective of this study was to assess the iatrogenic risk to the superficial femoral artery (SFA) during Less Invasive Stabilisation System (LISS) plate fixation of distal femoral fractures by analysing the range of distances and angles between LISS plate screws and the drilling line to the SFA. MATERIALS AND METHODS We identified all patients who underwent LISS plate fixation of distal femoral fractures between 2008 and 2018 in our level-1 trauma centre. Patients who underwent postoperative computed tomography for any reason were eligible for inclusion in the study. Twenty-five patients met the inclusion criteria. The sample comprised 10 male and 15 female patients with a mean age of 55 years. The most common fracture type was a supracondylar femur fracture (56%), followed by an intercondylar fracture (36%). A 13-hole LISS plate was the most common plate length used (44%). A consultant radiologist reviewed all scans to verify the visibility and marking of the SFA. RESULTS The median distance between the screw tip and the SFA was 21 mm (range, 8-65 mm). There was a negative correlation between the LISS plate hole number and the trajectory of drilling (Pearson coefficient: -0.87, p < 0.001). Using a linear regression model, the SFA was more likely to be in the line of drilling when the 6th to 10th holes in the LISS plate were used. CONCLUSION Extra care is needed when drilling into the LISS plate holes from the lateral to the medial direction in order to reduce the risk of iatrogenic injury to the SFA, especially in the high-risk plate zone where the artery can be close to the drilling line.
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Affiliation(s)
- Saeed Asadollahi
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - David Holcdorf
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Damien L Stella
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery (RMH), The University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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Mehta CR, Constantinidis A, Farhat M, Suthersan M, Graham E, Kanawati A. The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury. J Orthop Surg Res 2018; 13:135. [PMID: 29866137 PMCID: PMC5987397 DOI: 10.1186/s13018-018-0847-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Iatrogenic injury to the femoral neurovascular bundle is not uncommon during primary and revision total hip replacement (THR) and can result in permanent weakness, pain and poor function. Prevention of injury to these structures relies on a sound knowledge of their relationships to the hip joint. Methods We studied 115 consecutive hip magnetic resonance imaging (MRI) results in order to identify objective relationships between these structures and the hip joint that can be used intraoperatively. Results We determined that the shortest mean distances of the femoral nerve, artery and vein from the hip joint are 23.62 (standard deviation, SD = 5.44), 19.62 (SD = 4.17) and 17.47 (SD = 4.41) mm, respectively. The femoral nerve was lateral to the hip joint in 30 (55.5%) left- and 37 (60.7%) right-sided hip joints. The femoral artery was located medial to the hip joint in 28 (51.9%) left- and 34 (55.7%) right-sided hips. The femoral vein was medial to the hip joint in 52 (96.3%) left- and 58 (95.1%) right-sided hips. Conclusion We have identified objective relationships between the hip joint and femoral neurovascular bundle that can be used with ease intraoperatively during THR. Our data show that patients with a low body weight and the elderly may be at a higher risk of iatrogenic injury due to increased proximity of the neurovascular structures to the hip. Application of this knowledge may serve to reduce the risk of iatrogenic injury to these structures and thereby improve patient satisfaction and outcomes.
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Affiliation(s)
- Cyrus R Mehta
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia.
| | - Alex Constantinidis
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Moussa Farhat
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Mayuran Suthersan
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Edward Graham
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Andrew Kanawati
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
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