Abstract
OBJECTIVES:: To examine the frequency of intra-articular placement of distal femoral traction pins and their proximity to the superficial femoral artery (SFA). METHODS:: Wires were placed in the distal femurs of 28 cadaveric knees at the adductor tubercle (ADT), the superior pole of the patella (SPP), and 2 cm proximal to SPP (SPP+2). A lateral fluoroscopic image was obtained after injection of radiopaque contrast to assess for joint penetration. Dissection was performed to confirm or refute fluoroscopic findings. The distance from each wire to the SFA was measured. RESULTS:: The percentage of intra-articular placement was higher (29%) at the ADT than the SPP+2 (0%) level. The mean (SD) distances from the ADT, SPP, and SPP+2 to the SFA were 7.4 (±1.8) cm, 5.7 (±1.7) cm, and 3.8 (±1.7) cm, respectively (P <0.0001). None of the wires penetrated the femoral artery. The proportion of wires judged to be intra-articular was not statistically different whether judged by fluoroscopy or anatomic dissection (exact P = 1.0). CONCLUSIONS:: Wires placed at the level of the ADT are at risk for capsular penetration. Risk of major vascular injury with transmedullary placement at all levels seems to be minimal. The optimum position for distal femoral pins remains unknown, but aiming >0.7 cm proximal to the ADT may lower the risk of intra-articular placement. No difference was detected between fluoroscopic arthrography and gross dissection.
| Original language | English (US) |
|---|---|
| Journal | Journal of Orthopaedic Trauma |
| Volume | 27 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2013 |
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Keywords
- distal femur anatomy
- femoral artery
- femur fracture
- Ilizarov
- septic arthritis
- skeletal traction
- traction
- traction pin
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
Cite this
Are distal femoral traction pins intra-articular? A cadaveric study. / McElvany, Matthew; Benninger, Brion; Smith, Sawyer; Mirza, Amer; Marshall, Lynn; Friess, Darin.
In: Journal of Orthopaedic Trauma, Vol. 27, No. 11, 11.2013.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Are distal femoral traction pins intra-articular? A cadaveric study
AU - McElvany, Matthew
AU - Benninger, Brion
AU - Smith, Sawyer
AU - Mirza, Amer
AU - Marshall, Lynn
AU - Friess, Darin
PY - 2013/11
Y1 - 2013/11
N2 - OBJECTIVES:: To examine the frequency of intra-articular placement of distal femoral traction pins and their proximity to the superficial femoral artery (SFA). METHODS:: Wires were placed in the distal femurs of 28 cadaveric knees at the adductor tubercle (ADT), the superior pole of the patella (SPP), and 2 cm proximal to SPP (SPP+2). A lateral fluoroscopic image was obtained after injection of radiopaque contrast to assess for joint penetration. Dissection was performed to confirm or refute fluoroscopic findings. The distance from each wire to the SFA was measured. RESULTS:: The percentage of intra-articular placement was higher (29%) at the ADT than the SPP+2 (0%) level. The mean (SD) distances from the ADT, SPP, and SPP+2 to the SFA were 7.4 (±1.8) cm, 5.7 (±1.7) cm, and 3.8 (±1.7) cm, respectively (P <0.0001). None of the wires penetrated the femoral artery. The proportion of wires judged to be intra-articular was not statistically different whether judged by fluoroscopy or anatomic dissection (exact P = 1.0). CONCLUSIONS:: Wires placed at the level of the ADT are at risk for capsular penetration. Risk of major vascular injury with transmedullary placement at all levels seems to be minimal. The optimum position for distal femoral pins remains unknown, but aiming >0.7 cm proximal to the ADT may lower the risk of intra-articular placement. No difference was detected between fluoroscopic arthrography and gross dissection.
AB - OBJECTIVES:: To examine the frequency of intra-articular placement of distal femoral traction pins and their proximity to the superficial femoral artery (SFA). METHODS:: Wires were placed in the distal femurs of 28 cadaveric knees at the adductor tubercle (ADT), the superior pole of the patella (SPP), and 2 cm proximal to SPP (SPP+2). A lateral fluoroscopic image was obtained after injection of radiopaque contrast to assess for joint penetration. Dissection was performed to confirm or refute fluoroscopic findings. The distance from each wire to the SFA was measured. RESULTS:: The percentage of intra-articular placement was higher (29%) at the ADT than the SPP+2 (0%) level. The mean (SD) distances from the ADT, SPP, and SPP+2 to the SFA were 7.4 (±1.8) cm, 5.7 (±1.7) cm, and 3.8 (±1.7) cm, respectively (P <0.0001). None of the wires penetrated the femoral artery. The proportion of wires judged to be intra-articular was not statistically different whether judged by fluoroscopy or anatomic dissection (exact P = 1.0). CONCLUSIONS:: Wires placed at the level of the ADT are at risk for capsular penetration. Risk of major vascular injury with transmedullary placement at all levels seems to be minimal. The optimum position for distal femoral pins remains unknown, but aiming >0.7 cm proximal to the ADT may lower the risk of intra-articular placement. No difference was detected between fluoroscopic arthrography and gross dissection.
KW - distal femur anatomy
KW - femoral artery
KW - femur fracture
KW - Ilizarov
KW - septic arthritis
KW - skeletal traction
KW - traction
KW - traction pin
UR - http://www.scopus.com/inward/record.url?scp=84887404763&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84887404763&partnerID=8YFLogxK
U2 - 10.1097/BOT.0b013e318291005c
DO - 10.1097/BOT.0b013e318291005c
M3 - Article
VL - 27
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
SN - 0890-5339
IS - 11
ER -