Vascular injury and orthopaedics

Parvızı, Javad

doi:10.1016/j.artd.2018.10.005

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…have previously established that the posterior quadrants are relatively safe when compared to the anterior quadrants where the external iliac and obturator neurovascular bundle are at risk in the superior and inferior quadrants, respectively [ 8 , 17 , 28 , 29 ]. Injury to these vessels, particularly the external iliac, are known to occur [ 7 , 9 , 11 , 17 , 20 , 21 , [30] , [31] , [32] , [33] , [34] , [35] , [36] ]. Other authors have characterized the distance to danger from the acetabular surface, and in the anterior acetabulum, this distance is nearly universally <20 mm [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

Wilson¹,

Pflederer²,

Schwartz³

et al. 2021

Arthroplasty Today

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Background Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration. Methods A radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, “down the wing,” obturator outlet, and a “quad” view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a “triple-shot series” consisting of the “quad,” obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated. Results In isolation, the “quad” view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons ( P < .001) when using the 3-view series. Conclusions This study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

Wilson¹,

Pflederer²,

Schwartz³

et al. 2021

Arthroplasty Today

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“…The focus in the literature, with regards to vascular injury during THA, has primarily been on intraoperative injury. Although most vascular injuries during total joint arthroplasty have been reported to occur due to trauma from retractor placement or traction [12], [13], in the series presented by Parvizi et al [11], direct laceration constituted the most common reason for injury during THA. These injuries are usually recognized intraoperatively [9], [11] and occasionally present in the early postoperative period [11].…”

Section: Introductionmentioning

confidence: 99%

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation

et al. 2019

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Vascular injury as a result of total hip arthroplasty (THA) represents an uncommon complication. Although these injuries typically present acutely, delayed presentation has been reported. In this case, a 70-year-old female presented with groin pain and medial thigh numbness 15 years after a left THA. After initially being misdiagnosed, repeat imaging revealed a large external iliac pseudoaneurysm as a result of a transacetabular screw penetrating the medial acetabular wall. The patient underwent staged endovascular exclusion of the pseudoaneurysm, percutaneous drainage, and revision THA. She had resolution of her symptoms. To our knowledge, this is the only reported case of a late vascular injury related to an aseptic THA with well-fixed components. Staged treatment with endovascular exclusion and revision THA is a viable approach.

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Location of Femoral Vessels Around the Acetabulum in Crowe Type 4 Dysplastic Hips

Dırvar

Ezici

Özcafer

et al. 2020

The Journal of Arthroplasty

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Vascular injury and orthopaedics

Cited by 3 publications

References 9 publications

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation

Location of Femoral Vessels Around the Acetabulum in Crowe Type 4 Dysplastic Hips

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