Anatomy of the lateral circumflex femoral artery: Does the direct anterior approach to the hip jeopardize vascularization of the proximal femur?

Hartog, Christoph; Metzler, Christoph; Meier, Christoph; Kalberer, Fabian; Wahl, Peter

doi:10.1016/j.otsr.2019.07.013

Cited by 13 publications

(7 citation statements)

References 27 publications

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“…Herein, the 3D analysis of the nutrient foramina on the surface topography of bones showed that the proximal femur had a substantial number of DZs. To protect the blood supply of the proximal femur, the anatomy of the LFCA and MFCA, together with associated terminal branches have been widely investigated ( 3 , 26 ). However, these studies disregarded information regarding the vessels found on the proximal femur’s surface, a gap that has been filled in the present study.…”

Section: Discussionmentioning

confidence: 99%

3D Mapping of Bone Channel of Blood Supply to Femoral Head in Proximal Femur

Quan

Wei

et al. 2022

Front. Surg.

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BackgroundA detailed depiction of nutrient foramina is useful for defining guidelines and minimising iatrogenic damage during hip surgery. Therefore, this study aimed to define the location and frequency of nutrient foramina in the proximal femur using mapping techniques.MethodsOne hundred dry human cadaveric proximal femurs, comprising 56 left and 44 right femurs, were scanned using a three-dimensional scanner, with scanning distance 200 mm, precision 0.01 mm, and measuring point 0.04 mm. The image resolution of 1,310,000 pixels was obtained. Digital imaging models were acquired from the proximal femur surface. All the nutrient foramina in each model were identified and marked. The nutrient foramina models were superimposed on one another and oriented to fit a standard template of the femur’s proximal aspect. Three-dimensional mapping in the proximal femur’s nutrient foramina was performed.ResultsThe nutrient foramina’s location and dense zones were identified. The dense zones were distributed along the vascular course and gaps between the muscle attachment sites. Eighteen dense zones were identified and found to be location-dependent. They were located in the central part of the fovea capitis femoris, subcapital and basicervical areas of the femoral neck, and muscle attachment gaps of the femoral trochanter.ConclusionsThe terminal branch of the nutrient vessels entering the nutrient foramina is at risk for iatrogenic damage during hip surgeries, especially in cases of close bone exposures. There are 18 dense zones that need to be considered for a safer approach to the proximal femur. To minimise iatrogenic damage to the nutrient vessels entering the nutrient foramina, the dense areas should be avoided when technically possible.

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Section: Discussionmentioning

confidence: 99%

3D Mapping of Bone Channel of Blood Supply to Femoral Head in Proximal Femur

Quan

Wei

et al. 2022

Front. Surg.

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“…Previous studies of the effect of previous hip surgery on the vascularization of the proximal femur have mainly focused on femoral neck fracture, surgical hip dislocation procedure, and antegrade intramedullary femoral nailing, but there is little research about pediatric DDH in relation to this issue [ 13 ]. Christoph Hartog et al found that arterial perfusion of the proximal femur is easily impaired after adult hip surgery, particularly after an anterior approach [ 14 ]. The incidence of AVN after open reduction for DDH varies between 4 and 66% [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Modified Smith–Petersen approach with rectus-sparing reduces severe avascular necrosis for developmental dysplasia of the hip at walking age: minimum 5-year follow-up

et al. 2022

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Background Developmental dysplasia of the hip (DDH) is one of the most common orthopedic malformations in children. Open reduction for DDH at walking age remains a major concern. The goal of this study is to evaluate the mid-term effect of a modified Smith–Petersen approach which preserves the rectus femoris on DDH at walking age, in particular avascular necrosis (AVN). Methods A retrospective review of DDH patients aged between 12 and 24 months was carried out between January 2010 and June 2016. Open reduction through the Smith–Petersen approach (Group A) and modified Smith–Petersen approach, which preserves the rectus femoris (Group B), were both used. Measurement of hip geometry included acetabular index, the International Hip Dysplasia Institute classification, and AVN degree. Clinical records included operation time, bleeding volume, and abduction angle. Results There were 101 children (119 hips) with DDH who met the inclusion criteria. There were 66 hips in Group A and 53 in Group B. The mean surgical age at open reduction was 17.0 ± 2.4 months, with a mean 104.9 ± 19.5 months at last follow-up. There was no statistical difference in surgical age between the two groups (17.2 vs. 16.4 months). There was no significant difference in the incidence of all types of clinically significant AVN between group A and group B (27.3 vs. 18.9%), but the incidence of severe AVN was lower in group B (19.7 vs. 5.7%, P = 0.026). In addition, the lower the age at the time of open reduction, the lower the severity of AVN (P = 0.002). Conclusions These mid-term data suggest that the modified Smith–Petersen approach with rectus-sparing could reduce severe AVN more than the classical Smith–Peterson approach in open reduction in DDH at walking age. In addition, early open reduction can reduce the postoperative degree of AVN.

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“…De plus, les lésions tendineuses et la trophicité musculaire évoluent de concert avec l'IG musculaire dans la littérature [16,34]. Nous n'avons pas évalué les lésions vasculaires qui pourraient également influer sur l'IG musculaire, notamment dans les VAMI [43]. Toutefois elles ne sont pas les causes les plus classiques d'IG et leur analyse nécessite une imagerie avec opacification vasculaire pouvant être à risque pour le patient.…”

Section: Discussionunclassified