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Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures

BACKGROUND: Femoral skeletal traction assists in the reduction and transient stabilization of pelvic, acetabular, hip, and femoral fractures when splinting is ineffective. Traditional teaching has recommended a medial entry site for insertion of the traction pin in order to minimize injury to the fe...

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Autores principales: Kwon, John Y, Johnson, Catherine E, Appleton, Paul, Rodriguez, Edward K
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827386/
https://www.ncbi.nlm.nih.gov/pubmed/20205875
http://dx.doi.org/10.1186/1749-799X-5-4
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author Kwon, John Y
Johnson, Catherine E
Appleton, Paul
Rodriguez, Edward K
author_facet Kwon, John Y
Johnson, Catherine E
Appleton, Paul
Rodriguez, Edward K
author_sort Kwon, John Y
collection PubMed
description BACKGROUND: Femoral skeletal traction assists in the reduction and transient stabilization of pelvic, acetabular, hip, and femoral fractures when splinting is ineffective. Traditional teaching has recommended a medial entry site for insertion of the traction pin in order to minimize injury to the femoral artery as it passes through Hunter's canal. The present anatomical study evaluates the risk to the femoral artery and other medial neurovascular structures using a lateral entry approach. METHODS: Six embalmed cadavers (twelve femurs) were obtained for dissection. Steinman pins were drilled from lateral to medial at the level of the superior pole of the patella, at 2 cm, and at 4 cm proximal to this point. Medial superficial dissection was then performed to identify the saphenous nerve, the superior medial geniculate artery, the adductor hiatus, the tendinous insertion of the adductor magnus and the femoral artery. Measurements localizing these anatomic structures relative to the pins were obtained. RESULTS: The femoral artery was relatively safe and was no closer than 29.6 mm (mean) from any of the three Steinman pins. The superior medial geniculate artery was the medial structure at most risk. CONCLUSIONS: Lateral femoral traction pin entry is a safe procedure with minimal risk to the saphenous nerve and femoral artery. Of the structures examined, only the superior medial geniculate artery is at a risk of iatrogenic injury due to its position. The incidence of such injury in clinical practice and its clinical significance is not known. Lateral insertion facilitates traction pin placement since it minimizes the need to move the contralateral extremity out of the way of the drilling equipment or the need to elevate or externally rotate the injured extremity relative to the contralateral extremity.
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spelling pubmed-28273862010-02-24 Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures Kwon, John Y Johnson, Catherine E Appleton, Paul Rodriguez, Edward K J Orthop Surg Res Research article BACKGROUND: Femoral skeletal traction assists in the reduction and transient stabilization of pelvic, acetabular, hip, and femoral fractures when splinting is ineffective. Traditional teaching has recommended a medial entry site for insertion of the traction pin in order to minimize injury to the femoral artery as it passes through Hunter's canal. The present anatomical study evaluates the risk to the femoral artery and other medial neurovascular structures using a lateral entry approach. METHODS: Six embalmed cadavers (twelve femurs) were obtained for dissection. Steinman pins were drilled from lateral to medial at the level of the superior pole of the patella, at 2 cm, and at 4 cm proximal to this point. Medial superficial dissection was then performed to identify the saphenous nerve, the superior medial geniculate artery, the adductor hiatus, the tendinous insertion of the adductor magnus and the femoral artery. Measurements localizing these anatomic structures relative to the pins were obtained. RESULTS: The femoral artery was relatively safe and was no closer than 29.6 mm (mean) from any of the three Steinman pins. The superior medial geniculate artery was the medial structure at most risk. CONCLUSIONS: Lateral femoral traction pin entry is a safe procedure with minimal risk to the saphenous nerve and femoral artery. Of the structures examined, only the superior medial geniculate artery is at a risk of iatrogenic injury due to its position. The incidence of such injury in clinical practice and its clinical significance is not known. Lateral insertion facilitates traction pin placement since it minimizes the need to move the contralateral extremity out of the way of the drilling equipment or the need to elevate or externally rotate the injured extremity relative to the contralateral extremity. BioMed Central 2010-01-22 /pmc/articles/PMC2827386/ /pubmed/20205875 http://dx.doi.org/10.1186/1749-799X-5-4 Text en Copyright ©2010 Kwon et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research article
Kwon, John Y
Johnson, Catherine E
Appleton, Paul
Rodriguez, Edward K
Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures
title Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures
title_full Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures
title_fullStr Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures
title_full_unstemmed Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures
title_short Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures
title_sort lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures
topic Research article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827386/
https://www.ncbi.nlm.nih.gov/pubmed/20205875
http://dx.doi.org/10.1186/1749-799X-5-4
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