Mirioglu Akif, Dalkir Kaan Ali, Olke Hakki Can, Eraslan Bugra, Kundakci Bugra, Bagir Melih, Deveci Mehmet Ali
Department of Orthopaedics and Traumatology, Faculty of Medicine, Cukurova University, Adana, Turkey.
Department of Orthopaedics and Traumatology, Baskent University, Adana Turgut Noyan Research and Training Center, Adana, Turkey.
J Orthop Surg Res. 2025 May 27;20(1):520. doi: 10.1186/s13018-025-05948-0.
Open fractures with bone and soft tissue loss pose significant challenges in orthopedic surgery. External fixator-assisted techniques, such as acute angulation and shortening, have been proposed to facilitate wound closure. However, the vascular implications of these techniques remain unclear. This cadaveric study aimed to evaluate the effect of acute angulation on arterial narrowing at the proximal tibia and distal femur, identifying angulation thresholds and comparing the vascular tolerance between these anatomical sites.
Eight lower extremities from four fresh-frozen cadavers were used. Osteotomies were performed at the distal femoral and proximal tibial metaphyses. An Ilizarov circular external fixator provided controlled angulation in varus, valgus, procurvatum, and recurvatum directions. A contrast agent was used for vascular visualization under fluoroscopy. Angulation was gradually increased until arterial narrowing was observed, and the critical angles were recorded.
In the proximal tibia, the mean angulation thresholds for arterial narrowing were 45.5° in varus, 26.5° in valgus, 33.8° in procurvatum, and 13.5° in recurvatum. In the distal femur, arterial narrowing occurred at 27° in varus, 32.3° in valgus, 52° in procurvatum, and 22° in recurvatum. Varus angulation was significantly better tolerated at the tibia (p = 0.0286), while procurvatum (p = 0.0294) and recurvatum (p = 0.0286) were better tolerated at the femur. No significant difference was found in valgus angulation (p = 0.559).
The tibia demonstrated higher tolerance for varus angulation, while the femur allowed greater procurvatum and recurvatum before vascular compromise. Recurvatum deformities in the tibia resulted in the earliest arterial narrowing, suggesting a higher risk of vascular complications. These findings provide critical insight for surgeons performing external fixator-assisted soft tissue coverage, helping optimize angulation strategies to prevent vascular complications.
伴有骨与软组织缺损的开放性骨折给骨科手术带来了重大挑战。已提出诸如急性成角和缩短等外固定器辅助技术以促进伤口闭合。然而，这些技术对血管的影响仍不清楚。本尸体研究旨在评估急性成角对胫骨近端和股骨远端动脉狭窄的影响，确定成角阈值并比较这些解剖部位之间的血管耐受性。
使用来自四具新鲜冷冻尸体的八个下肢。在股骨远端和胫骨近端干骺端进行截骨术。一个Ilizarov环形外固定器在内翻、外翻、前凸和后凸方向提供可控成角。在荧光透视下使用造影剂进行血管可视化。逐渐增加成角直至观察到动脉狭窄，并记录临界角度。
在胫骨近端，动脉狭窄的平均成角阈值在内翻时为45.5°，外翻时为26.5°，前凸时为33.8°，后凸时为13.5°。在股骨远端，内翻时27°出现动脉狭窄，外翻时32.3°，前凸时52°，后凸时22°。胫骨对内翻成角的耐受性明显更好（p = 0.0286），而股骨对前凸（p = 0.0294）和后凸（p = 0.0286）的耐受性更好。外翻成角无显著差异（p = 0.559）。
胫骨对内翻成角具有更高的耐受性，而股骨在血管受损前允许更大的前凸和后凸。胫骨的后凸畸形导致最早的动脉狭窄，提示血管并发症风险更高。这些发现为进行外固定器辅助软组织覆盖的外科医生提供了关键见解，有助于优化成角策略以预防血管并发症。
