Are distal femoral traction pins intra-articular? A cadaveric study

Matthew McElvany, Brion Benninger, Sawyer Smith, Amer Mirza, Lynn Marshall, Darin Friess

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 languageEnglish (US)
JournalJournal of Orthopaedic Trauma
Volume27
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Patella
Traction
Thigh
Joints
Femoral Artery
Dissection
Arthrography
Femur
Knee
Injections

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 journalArticle

McElvany, Matthew ; Benninger, Brion ; Smith, Sawyer ; Mirza, Amer ; Marshall, Lynn ; Friess, Darin. / Are distal femoral traction pins intra-articular? A cadaveric study. In: Journal of Orthopaedic Trauma. 2013 ; Vol. 27, No. 11.
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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.

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