Changes in the anatomical position of the superficial and deep femoral arteries during internal fixation of intertrochanteric fractures

Abstract

Fixation for intertrochanteric proximal femoral fractures are increasing globally, one of the risks with surgical treatment is injury to the deep and superficial femoral arteries (DFA and SFA, respectively). The anatomic path of these vessels has been previously described, though the effect of reduction techniques, such as traction over a perineal post has not been well defined. This study addresses the question of: do closed reduction maneuvers on an orthopaedic trauma traction table affect the anatomical relationship of superficial and deep femoral arteries to the proximal femur in intertrochanteric proximal femoral fractures? Prospective observational single centre study of seventeen patients with pertrochanteric femoral fractures examined before and after applying traction for closed reduction. Doppler ultrasound was used to determine the proximity of these arteries to the proximal medial femoral cortex at three different levels. Our data demonstrates that internal rotation of the injured limb during reduction draws the arteries statistically closer to the medial cortex of the proximal femoral shaft at 3.5cm and 10.5cm distal to the lesser trochanter (SFA: 3.5cm - 38.0mm vs 34.7mm p 0.004, 10.5cm – 30.4mm vs 21.0mm p 0.02; DFA: 3.5cm – 26.4mm vs 22.3mm p 0.003, 10.5cm - 21.5mm vs 14.1mm p 0.007). No significant change in the artery position was noted in patients who did not require internal rotation to achieve fracture reduction. Surgeons performing these internal fixation procedures need to be aware of the anatomical changes to ensure patient safety and avoid complications including intramuscular haematomas and pseudoaneurysms. • Internal rotation laterally displaces the femoral artery during fixation on an orthopaedic traction table. • Care should be taken to avoid drill plunge beyond the medial femoral cortex. • Deep femoral artery is most ‘at risk’ of injury when using plate or distal locked nail constructs.