Evaluation of Safe Zones for Medial Approach to the Distal Femur Using Computed Tomography Angiography
DOI:
https://doi.org/10.63403/re.v32i3.413Keywords:
Femur fracture, Medial approach, Femoral artery, Medial plate, Computed tomography angiographyAbstract
Introduction: distal femur fractures represent a surgical challenge due to the anatomical complexity of the región and the significant functional implications they may entail. The medial aspect of the distal femur contains critical vascular structures, such as branches of the profunda femoris artery, whose detailed localization is essential to minimize intraoperative vascular injury. In the Chilean population, specific anatomical characteristics, such as shorter stature, may influence the relative positioning of these structures.
Objectives: this study aimed to define vascular-safe zones for medial approaches in distal femur surgery through radiological analysis.
Materials and methods: a cross-sectional study was conducted using 50 CT angiographies of the lower limbs (from 25 patients) performed between May and June 2020. Exclusions included femoral fractures, amputations, and occlusive arterial disease. Measurements were taken from the medial femoral condyle joint line and adductor tubercle to the femoral artery and its descending genicular branch in sagittal, coronal, and axial planes. Statistical analysis included ANOVA and post hoc Bonferroni with p <0.05.
Results: 32 angiographies met the inclusion criteria. The mean distance from the joint line to the femoral artery was 21.2 ± 2.15 cm, and to the descending genicular artery, 12.8 ± 2.65 cm. From the adductor tubercle, distances were 16.6 ± 2.12 cm and 8.15 ± 2.63 cm, respectively. Greater distances were found in women for the femoral artery (p=0.0304). No significant differences were found by side or age, except for a shorter distance to the descending genicular artery in older age groups (p=0.001).
Conclusion: this study established a safety distance from the joint line of the medial condyle of 21.2 cm ± 2.15 cm to the femoral artery and 12.8 cm ± 2.65 cm to the descending genicular artery. Similarly, safe margins were defined from the adductor tubercle of 16.6 cm ± 2.12 cm and 8.15 cm ± 2.63 cm, respectively. These findings support the planning of safer medial approaches, including the potential placement of a medial plate in selected clinical scenarios.
Level of evidence: IV. Descriptive Cross-Sectional Study
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Copyright (c) 2025 Jorge Isla Villanueva, Alfredo Sandoval Ibañez, Rodrigo Guiloff Krauss, Matín Cañas Prieto, Francisco Figueroa Berrios, Rafael Calvo Mena, David Figueroa Poblete
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This work is published under a Creative Commons Attribution–NonCommercial–ShareAlike 4.0 International License (CC BY-NC-SA 4.0). The authors retain the copyright.
