TAILIEUCHUNG - Kwon et al. Journal of Orthopaedic Surgery and Research 2010, 5:4

Kwon et al. Journal of Orthopaedic Surgery and Research 2010, 5:4 RESEARCH ARTICLE Open Access Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures John Y Kwon1*, Catherine E Johnson1, Paul Appleton2, Edward K Rodriguez2 Abstract Background: Femoral skeletal traction assists in the reduction and transient stabilization of pelvic, acetabular, hip, and femoral fractures when splinting is ineffective. Traditional teaching has recommended a medial entry site for insertion of the traction pin in order to minimize injury to the femoral artery as it passes through Hunter’s canal. The present anatomical study evaluates the risk to the femoral artery and. | Kwon et al. Journal of Orthopaedic Surgery and Research 2010 5 4 http content 5 1 4 JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH RESEARCH ARTICLE Open Access Lateral femoral traction pin entry risk to the femoral artery and other medial neurovascular structures John Y Kwon 1 Catherine E Johnson1 Paul Appleton2 Edward K Rodriguez2 Abstract Background Femoral skeletal traction assists in the reduction and transient stabilization of pelvic acetabular hip and femoral fractures when splinting is ineffective. Traditional teaching has recommended a medial entry site for insertion of the traction pin in order to minimize injury to the femoral artery as it passes through Hunter s canal. The present anatomical study evaluates the risk to the femoral artery and other medial neurovascular structures using a lateral entry approach. Methods Six embalmed cadavers twelve femurs were obtained for dissection. Steinman pins were drilled from lateral to medial at the level of the superior pole of the patella at 2 cm and at 4 cm proximal to this point. Medial superficial dissection was then performed to identify the saphenous nerve the superior medial geniculate artery the adductor hiatus the tendinous insertion of the adductor magnus and the femoral artery. Measurements localizing these anatomic structures relative to the pins were obtained. Results The femoral artery was relatively safe and was no closer than mm mean from any of the three Steinman pins. The superior medial geniculate artery was the medial structure at most risk. Conclusions Lateral femoral traction pin entry is a safe procedure with minimal risk to the saphenous nerve and femoral artery. Of the structures examined only the superior medial geniculate artery is at a risk of iatrogenic injury due to its position. The incidence of such injury in clinical practice and its clinical significance is not known. Lateral insertion facilitates traction pin placement since it minimizes the need to move the

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