An anteromedial approach of the hip for Pipkin Ⅰ and Ⅱ femoral head fractures: an imaging and anatomical study
10.3760/cma.j.cn115530-20241225-00505
- VernacularTitle:髋关节前内侧入路治疗PipkinⅠ、Ⅱ型股骨头骨折的影像学和解剖学研究
- Author:
Junjie GUAN
1
;
Chenjun LIU
1
;
Zhiyuan FAN
1
;
Xin QI
1
;
Ning XU
1
;
Weichao YANG
1
;
Hui SUN
1
;
Sa SONG
1
;
Wei ZHANG
1
Author Information
1. 上海交通大学医学院附属第六人民医院骨科，上海 200233
- Publication Type:Journal Article
- Keywords:
Femoral artery;
Femoral nerve;
Femur head;
Fractures, bone;
Anatomy;
Anteromedial approach of the hip
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(3):210-215
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore a new surgical approach [anteromedial approach of the hip (AMA)] for Pipkin Ⅰ and Ⅱ femoral head fractures through an imaging and anatomical study.Methods:The hip imaging data were collected of the 38 patients who had undergone lower limb CT angiography for open tibiofibular fractures at Department of Orthopaedics, The Sixth People’s Hospital, School of Medicine, Shanghai Jiao Tong University from June 2023 to January 2024. There were 20 males aged (40.9±3.5) years and 18 females aged (41.5±3.3) years. The origins and shapes of the femoral artery and its main branches were observed. The distances between the femoral head and the femoral artery, the medial femoral circumflex artery, and the lateral femoral circumflex artery were measured. Four fresh adult cadavers were collected, including 2 males and 2 females. Their ages of death were 56, 65, 72 and 78 years old, respectively. An incision was made along the axis of the limb at the midpoint of the inguinal ligament at the 4 fresh cadavers. After the femoral head was exposed through the gap between the femoral artery and the femoral nerve, the range of the femoral head exposed was marked.Results:The femoral artery ran along the anteromedial side of the femoral head. The shortest distance between the medial femoral circumflex artery and the femoral head was (13.1±5.7) mm, and the shortest distance between the origin of the lateral femoral circumflex artery and the femoral head (21.6±8.6) mm. On the lateral view of CT angiography, the distance between the femoral artery and the femoral head was (20.6±4.9) mm at the level of the apex of greater trochanter. Gross observation on the cadavers found only small branches of vessels between the femoral artery and the femoral nerve. After the femoral artery and femoral nerve were respectively pulled medially and laterally, the anterior-inferior part of the femoral head was exposed directly by pulling the muscles to open the joint capsule. The exposure range of the femoral head was further expanded through internal and external rotation of the hip joint under traction. The anatomical gap between the femoral artery and the femoral nerve was named the AMA.Conclusion:AMA utilizes the potential gap between the femoral artery and the femoral nerve, providing a new surgical approach for exposure and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures.
