Cadaveric analysis of capsular attachments of the distal femur related to pin and wire placement

Lowery, Kathryn; Dearden, Paul; Sherman, Kathleen; Mahadevan, Vishy; Sharma, Hemant

doi:10.1016/j.injury.2015.03.017

Cited by 14 publications

(4 citation statements)

References 10 publications

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“…Authors concluded that pins should be inserted at least 0.7 cm proximal to the adductor tubercle. Furthermore, Lowery et al demonstrated that on the medial side, the capsule reflection can be up to 74% of the distance between the anterior aspect of the medial femoral condyle and the adductor tubercle [13]. Authors of this study also recommend pin placement proximal to the adductor tubercle.…”

Section: Discussionmentioning

confidence: 73%

“…Authors of this study also recommend pin placement proximal to the adductor tubercle. The capsule reflection on the lateral side was also found to attach more posteriorly, by up to 57% of the anterior-posterior femoral diameter [13]. The authors therefore suggested that pins should exit more posteriorly to avoid penetration of the capsule.…”

Section: Discussionmentioning

confidence: 92%

“…Most studies suggest that pin insertion at least 8-14 mm distal to the proximal tibial subchondral line excludes intracapsular placement [8,10,11]. On the other hand, the interindividual variation of knee capsular insertion on the distal femur is less well described in the literature [4,6,13].…”

Section: Introductionmentioning

confidence: 99%

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Knee Capsule Anatomy: An MR Imaging and Cadaveric Study

et al. 2021

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This research focuses on the anatomical insertion of the synovial capsule around the knee. The attachments of the capsule were measured in 50 knee MR imaging studies with large intraarticular effusion. Corresponding measurements were performed in 20 fresh frozen cadaveric specimens, for validation. Femoral and tibial capsular reflections were defined as the distances between the attachment sites of the capsule and the femoral or tibial joint line and they were recorded in three coronal planes (anterior/middle/posterior). On MR imaging, the lateral/medial femoral capsular reflection mean values were 6.5/4.57 cm, 2.74/1.74 cm and 1.52/1.99 cm in the anterior, middle and posterior plane, respectively. MR imaging-based measurements did not differ significantly compared to corresponding cadaveric measurements. The mean values of the lateral/medial tibial capsular reflection on MR imaging were 0.09/0.11 cm, 0.34/0.26 cm and 0.62/0.34 cm in the anterior, middle and posterior plane, respectively. On cadaveric dissection, the maximum mean value was 1.45 cm, measured on the lateral side of the anterior plane. Apart from the lateral aspect of the posterior plane, MR imaging measurements were significantly lower, compared to the corresponding cadaveric measurements. The greatest femoral and tibial capsular reflections were found on the anterior and lateral side of the anterior plane. MR imaging appears to underestimate the distal extent of the knee capsule. Anatomical details of the knee capsule should be considered for safe insertion of external fixator pins.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 92%

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Knee Capsule Anatomy: An MR Imaging and Cadaveric Study

et al. 2021

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“…Good knowledge of the anatomy around the knee is needed to avoid iatrogenic knee capsule penetration, which may place patients at risk of septic arthritis, or damage to neurovascular structures. 5 In addition, there have been case reports of complications such as pin site infection, iatrogenic fracture, sciatic nerve palsy, and heterotopic ossification associated with traction pins. [6][7][8] At our institution, we place approximately 400 to 500 traction pins in the emergency department per year.…”

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confidence: 99%

Implementing an Educational Module for Orthopaedic Residents Placing Skeletal Traction

et al. 2023

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Introduction:Although placement of a distal femoral traction (DFT) pin is a relatively simple procedure used to stabilize femoral and pelvic fractures, it places patients at risk of iatrogenic vascular, muscular, or bony injury. We designed and implemented an educational module combining theory and practical experience to standardize and improve resident teaching on the placement of DFT pins.Methods:We introduced a DFT pin teaching module into our second-year resident “boot camp,” which is used to help prepare residents for taking primary call in the emergency department at our level I trauma center. Nine residents participated. The teaching module included a written pretest, an oral lecture, a video demonstration of the procedure, and a practice simulation on 3D printed models. After completing the teaching, each resident underwent a written examination and proctored live simulation involving 3D models using the same equipment available in our emergency department. Pre-teaching and post-teaching surveys were used to assess resident experience and confidence with placing traction in the emergency department.Results:Before the teaching session, the rising postgraduate year 2 residents scored an average of 62.2% (range, 50% to 77.8%) on the DFT pin knowledge quiz. This improved to an average of 86.6% (range, 68.1% to 100%) (P = 0.0001) after the teaching session. After completing the educational module, they also demonstrated an improvement in confidence with the procedure, from 6.7 (range, 5 to 9) to 8.8 (range, 8 to 10) (P = 0.04).Discussion:Despite reporting high levels of confidence in their ability to place traction pins before starting the postgraduate year 2 consult year, many residents also reported anxiety around the accurate placement of traction pins. Early results of our training program showed improved resident knowledge of safe placement of traction pins and improved confidence with the procedure.

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