Proximal femoral fractures and vascular injuries in adults: Incidence, aetiology and outcomes

摘要: Abstract Introduction Vascular injuries (VI) presenting during internal fixation (IF) of proximal femoral fractures (PFF) are potentially limb- and life-threatening. The purpose this systematic review the literature is to report on their incidence, associated complications give special emphasis in prevention. Materials methods A comprehensive was undertaken using PRISMA guidelines with no language restriction. Case reports VIPFF-IF series PFF-IF cases VI published between inception journals March 2015 were eligible for inclusion. Relevant information divided two parts. Part I included analysis VIPFF-IF, objective establishing frequency injury each vessel, types mechanisms injury, diagnostic therapeutic modalities, outcomes. II analysed PFF-IF, which case(s) assessing incidence VIPFF-IF. Results Overall 160 articles 182 met inclusion criteria. extrapelvic vessels prevailed over those intrapelvic vessels. There a higher deep artery its branches external iliac vein were: compression, intimal flap tear, disruption layer thrombosis, laceration haemorrhage, puncture or progressive erosion leading pseudoaneurysm (PSA) arteriovenous fistula (AVF), high prevalence PSA, followed by lacerations. PSAs more frequent lesions lacerations 7 non-iatrogenic injuries, produced displaced lesser trochanter fragment other bone fragments, 175 iatrogenic (96.15%). intraoperative protrusion instruments implants, post-operative migration implants For prevalent mechanism fragment, either intra- postoperatively, an overshot drill bit protruding screw; several completed list. clinical radiological investigations similar elsewhere. occurred at time fracture, surgery after it, early late, weeks, months even years IF. modalities most diverse, morbidity mortality 18.06%. overall 0.49%. Conclusion low, though it will probably rise because increasing PFF. With few exceptions, these limb life-threatening, iatrogenic, resulting errors IF, different running close proximity bone. Although surgeon should bear mind possibility achieve diagnosis prompt accurate treatment, there consensus as what best modality. precise preoperative vascular status limb, monitoring displacement careful gentle reduction handling implant selection placement factors consider order prevent complication, never be underestimated.