Anatomical Considerations in the Utilisation of Minimally Invasive Cerclage Wiring for Femoral Fracture Fixation
Abstract
Introduction: Cerclage wiring remains a popular reduction tool in managing complex fractures of the femur. We propose that the direction in which the minimally-invasive wire passer (MI-WP) is inserted should be considered distinct from that of the conventional wire passer to minimise vessel injury.
Materials and methods: The computed-tomographic angiograms of 101 limbs from 78 unique patients from 2010 to 2017 were reviewed. We identified three common levels of wiring: the lesser trochanter (LT), midshaft of the femur, and the adductor tubercle. The position of and the shortest distance from the outer cortex of the femur to the superficial femoral artery (SFA) and the profunda femoris artery (PFA) at these levels were recorded.
Results: The mean distance of the SFA to the LT and femur midshaft was 6.8mm further in a male compared to a female (p<0.001). Males showed a significantly further distance from the PFA to the LT and femur midshaft (p<0.001 and p=0.009, respectively). There was a significantly shorter distance from the SFA and PFA to the femur at the LT of 0.2mm (95% CI: 0.1-0.2) and 0.1mm (95% CI: 0.1-0.2), respectively, for each 1-year increase in age (p<0.001).
Conclusion: Responsible use of the MI-WP requires that the surgeon is aware of its differences from other wire passers; in particular, one of the jaws of one forceps-half extends forward by approximately 5mm during assembly. To minimise the risk of vessel injury, safe usage of the MI-WP should consider both the position of the extending forceps-jaw and the angle of insertion with respect to the surrounding vessels.
Abstract | Reference
