OTA 2012 Posters

Scientific Poster #31 Hip/Femur OTA-2012

Percutaneous Plating of the Distal Femur: Risk of Injury to the Perforating Branches of the Profunda Femoris Artery

Adam Baker, MD; Brent Roster, MD; Amer J. Mirza, MD;
Oregon Health & Sciences University, Portland, Oregon, USA

Purpose: Our objective was to map the anatomic course of the perforating branches of the profunda femoris artery to determine the risk of injury during percutaneous plate insertion along the lateral femoral shaft.

Methods: 37 adult fresh-frozen cadaveric lower extremity specimens were instrumented with precontoured distal femoral periarticular plates. The specimens were dissected and the location, diameter, number, and course of the deep perforating arteries and their branches were noted with respect to the lateral femoral cortex and distance from the articular surface of the lateral femoral condyle. The incidence of perforating artery injury was determined and quantified with respect to plate hole number.

Results: There were an average of 5.1 (SD 1.2) perforating arteries (PAs) per cadaveric limb. Arteries were numbered numerically from distal to proximal with the most distal perforating vessel as number 1. The average diameter of each PA was 0.67 cm (0.33) for PA-1, 0.72 cm (0.41) for PA-2, 1.04 cm (0.60) for PA-3, 1.02 cm (0.55) for PA-4, 0.87 cm (0.53) for PA-5, 0.69 cm (0.35) for PA-6, and 0.84 cm (0.23) for PA-7. At the level of the midsagittal femur cortex, 52% of PAs had 0 branches, 2% had 1 branch, 31% had 2 branches, 13% had 3 branches, and 3% had 4 branches. The distance from the midportion articular surface of the lateral femoral condyle to each PA in both centimeters and percentage of total femur length averages 10.51 cm (24%) for PA-1, 17.97 cm (41%) for PA-2, 22.04 cm (52%) for PA-3, 25.28 cm (54%) for PA-4, 26.66 cm (60%) for PA-5, 29.21 cm (66%) for PA-6, and 29.09 cm (66%) for PA-7. The frequency of injury to the different PAs was 85% PA-1, 84% PA-2, 81% PA-3, 84% PA-4, 80% PA-5, 82% PA-6, and 100% for PA-7. The corresponding holes in the 16-hole Synthes LCP plate were hole numbers 3, 4 for PA-1, hole numbers 6, 7 for PA-2, hole numbers 8-10 for PA-3, hole numbers 11, 12 for PA-4, hole numbers 12, 13 for PA-5, hole numbers 13, 14 for PA-6, and hole numbers 13-15 for PA-7. The corresponding holes in the 18-hole Zimmer 5.5-mm Locking Distal Femur Plate were hole number 3 for PA-1, hole numbers 5, 6 for PA-2, hole numbers 8-11 for PA-3, hole numbers 11, 12 for PA-4, hole numbers 12, 13 for PA-5, hole numbers 13, 14 for PA-6, and hole numbers 13-15 for PA-7. The corresponding holes in the 16-hole Smith & Nephew 4.5-mm PERI-LOC Distal Femur Plate were hole numbers 4, 5 for PA-1, hole numbers 6, 7 for PA-2, hole numbers 9-11 for PA-3, hole numbers 11, 12 for PA-4, hole number 13 for PA-5, hole numbers 13, 14 for PA-6, and hole numbers 14, 15 for PA-7.

Conclusion: The deep perforating branches of the profunda femoris are at risk of injury during submuscular minimally invasive plating techniques for stabilization of distal femoral fractures. Our study demonstrated a consistent number and pattern of perforating branches of the profunda femoris artery. We noted an average of 80% injury rate to the perforating arteries or one of their branches. An understanding of the anatomic course of the profunda femoris perforating arteries can be used during minimally invasive plating techniques of the distal femur.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.