A safe percutaneous technique for the reduction of irreducible femoral neck fractures using ultrasound localization of the femoral vascular and nervous structures at the hip

Abstract

We present a safe percutaneous technique for the placement of Kirschner wires into the femoral head to assist in the reduction of irreducible femoral neck fractures using ultrasound to identify the vascular and nervous structures about the hip. From January 2011 to June 2014, a total of 36 patients (25 males and 11 females) were enrolled in this study. Patients were placed on a fracture reduction table for limb traction. After 3 unsuccessful reductions with limb traction, ultrasound-guided localization of the patient's femoral artery, vein, and nerve at the hip was performed. These structures were marked on the overlying skin and then Kirschner wires were inserted into the femoral head avoiding these marked structures. After the surgery, the Kirschner wire insertions were routinely reviewed by ultrasound, the hip fracture reduction and the femoral nerve sensorimotor function were routinely examined as well. All 36 patients with an irreducible variant of a femoral neck fracture showed anatomic reduction under C-arm fluoroscopy using ultrasound to avoid K wire injury to the femoral vascular structures and nerve. No major vascular injury during operation. In post-surgical ultrasound examination, local hematoma formation was not evident. There was normal function of the femoral nerve. On follow-up, there were no infections, wound problems, recurrence of fracture displacement, laxity, or implant breakage. Preoperative ultrasonic localization of the femoral artery, vein, and femoral nerve safely allowed. Kirschner wire placement under C-arm fluoroscopy into the femoral head to assist in fracture reduction. This assisted reduction method for irreducible femoral neck fractures had a number of advantages, including closed anatomic reduction with minimal attempts, used simple equipment, and avoided further destruction of the blood supply to the femoral head.

Can intraoperative ultrasound visualize the closed reduction and elastic intramedullary nail fixation processes of double forearm fractures in children?

“… [9] Mahaisavariya et al reported on adult intramedullary nail fixations under ultrasound monitoring. [10] Yu et al have also reported similar findings, [11] but no studies on children have been reported.…”

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

“…This is in accordance with our study, where 83.3% (5/6) of the patients with trans xion pin injuries recovered completely. We believe that in the future, high-risk patients, such as those with obesity, may warrant B-mode ultrasound-guided pin placement to reduce the development of complications, similar to the method used by Yu et al [18] for the reduction of femoral neck fractures.…”

High-energy Femoral Neck Fractures in Young Patients

“…The importance of anatomic reduction of these fractures has led to multiple descriptions of surgical techniques to achieve the best possible reduction. [18][19][20] Yu et al 18 described a percutaneous reduction method using Kirschner wires as joysticks and ultrasonography for localization of important structures to prevent injury. This is a relatively limited series, however, with 36 patients and four postoperative complications (one planned total hip, one osteonecrosis, one screw migration, and one screw loosening).…”