 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2024, vol. 30, issue3
Subject Area: Medicine
-
DOI: 10.5272/jimab.2024303.5627
Published online: 10 July 2024
Case report
J of IMAB. 2024 Jul-Sep;30(3):5627-5630
FEMORAL SHAFT FRACTURE WITH TOTAL SUPERFICIAL FEMORAL ARTERY AND VEIN RUPTURE FOLLOWING TRACTION MECHANISM TYPE OF INJURY – A CASE REPORT
Emil Simeonov
,
Department of Orthopaedics and Traumatology, Faculty of Medicine, Medical University – Pleven, Bulgaria.
ABSTRACT:
The majority of encountered femoral artery lesions are due to penetrating or stab injuries. In cases of closed femoral fractures, artery damages could be missed due to their rarity, as surgeons might not anticipate them on the first encounter with the injured person.
Damage Control Orthopaedics (DCO) provides a pathway to managing patients with severe orthopaedic injuries, particularly when the trauma is complicated by vascular injuries, such as femoral artery rupture. The DCO approach prioritizes stabilizing the patient before definitive bone fixation. This way, it provides a stable environment to reconstruct damaged arteries, prevent the secondary inflammatory response, provide hemodynamic stability, and prevent other complications associated with prolonged surgeries.
In this case, a 48-year-old man experienced high-energy trauma on his left leg and arrived at the emergency department eight hours after the incident. Upon his arrival, a noticeable deformity was observed in the lower thigh area. X-ray imaging disclosed a distal femoral fracture. Further examination revealed a lack of knee and ankle function, full paraesthesia below the knee region, and absent pedal pulses.
Following a CT angiography, a complete rupture of the superficial femoral artery was confirmed. This case was treated with temporary external fixation, femoral artery reconstruction, and prophylactic fasciotomy. External fixation has been later converted to definitive intramedullary fixation.
Keywords: Vascular injury, intramedullary interlocking nail, closed femur shaft fracture,
- Download FULL TEXT /PDF 871 KB/
Please cite this article as: Simeonov E. Femoral shaft fracture with total superficial femoral artery and vein rupture following traction mechanism type of injury – a case report. J of IMAB. 2024 Jul-Sep;30(3):5627-5630. [Crossref - 10.5272/jimab.2024303.5627]
Correspondence to: Dr. Emil Simeonov, MD, PhD, Clinic of Orthopaedics & Traumatology, UMBAL "Dr. Georgi Stranski"- Pleven; 89, Ruse Blvd., Pleven 5803, Bulgaria; E-mail: emil.simeonov.pl@gmail.com
REFERENCES:
1. Rayamajhi S, Murugan N, Nicol A, Edu S, Klopper J, Naidoo N, et al. Penetrating femoral artery injuries: an urban trauma centre experience. Eur J Trauma Emerg Surg. 2019 Oct;45(5):909-917. [PubMed]
2. Kluger Y, Gonze MD, Paul DB, DiChristina DG, Townsend RN, Raves JJ, et al. Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern. J Trauma. 1994 Feb;36(2):222-5. [PubMed]
3. Cargile JS 3rd, Hunt JL, Purdue GF. Acute trauma of the femoral artery and vein. J Trauma. 1992 Mar;32(3):364-70. [PubMed]
4. Asensio JA, Kuncir EJ, García-Núñez LM, Petrone P. Femoral vessel injuries: analysis of factors predictive of outcomes. J Am Coll Surg. 2006 Oct;203(4):512-20. [PubMed]
5. Krishna SV, Sindhu B, Suhas TR, Sumanahalli CH. Femoral Artery Injuries in Closed Femur Shaft Fractures: Case Report. Surg J (NY). 2022 Oct 13;8(3):e219-e223. [PubMed]
6. Coleman JJ, Tavoosi S, Zarzaur BL, Brewer BL, Rozycki GS, Feliciano DV. Arterial Injuries Associated with Blunt Fractures in the Lower Extremity. Am Surg. 2016 Sep;82(9):820-4. [PubMed]
7. Jones RE, Smith EC, Bone GE. Vascular and orthopedic complications of knee dislocation. Surg Gynecol Obstet. 1979 Oct;149(4):554-8. [PubMed]
8. Smith RF, Szilagyi E, Elliott JP Jr. Fracture of long bones with arterial injury due to blunt trauma. Principles of management. Arch Surg. 1969 Sep;99(3):315-24. [PubMed]
9. Rowe VL, Salim A, Lipham J, Asensio JA. Shank vessel injuries. Surg Clin North Am. 2002 Feb;82(1):91-104. [PubMed]
10. Perron AD, Brady WJ, Sing RF. Orthopedic pitfalls in the ED: vascular injury associated with knee dislocation. Am J Emerg Med. 2001 Nov;19(7):583-8. [PubMed]
11. Fallon G, Thomford NR. False aneurysm of the superficial femoral artery associated with fracture of the femur. Angiology. 1970 Feb;21(2):120-3. [PubMed]
12. McGee SR, Boyko EJ. Physical examination and chronic lower-extremity ischemia: a critical review. Arch Intern Med. 1998 Jun 22;158(12):1357-64. [PubMed]
13. Bellemans J, Stockx L, Peerlinck K, Vermylen J, Lacroix H, Suy R. Arterial occlusion and thrombus aspiration after total knee arthroplasty. Clin Orthop Relat Res. 1999 Sep;(366):164-8. [PubMed]
14.Alarhayem AQ, Cohn SM, Cantu-Nunez O, Eastridge BJ, Rasmussen TE. Impact of time to repair on outcomes in patients with lower extremity arterial injuries. J Vasc Surg. 2019 May;69(5):1519-1523. [PubMed]
15. DiChristina DG, Riemer BL, Butterfield SL, Burke CJ 3rd, Herron MK, Phillips DJ. Femur fractures with femoral or popliteal artery injuries in blunt trauma. J Orthop Trauma. 1994 Dec;8(6):494-503. [PubMed]
16. Zlowodzki M, Prakash JS, Aggarwal NK. External fixation of complex femoral shaft fractures. Int Orthop. 2007 Jun;31(3):409-13. [PubMed]
17. Jin L, Zhang S, Zhang Y, Lin X, Feng D, Hu K. Management algorithm of external fixation in lower leg arterial injury for limb salvages. BMC Surg. 2022 Mar 3;22(1):79. [PubMed]
18. Guerado E, Bertrand ML, Cano JR, Cerván AM, Galán A. Damage control orthopaedics: State of the art. World J Orthop. 2019 Jan 18;10(1):1-13. [PubMed]
19. Volpin G, Pfeifer R, Saveski J, Hasani I, Cohen M, Pape HC. Damage control orthopaedics in polytraumatized patients- current concepts. J Clin Orthop Trauma. 2021 Jan;12(1):72-82. [PubMed]
Received: 07 March 2024
Published online: 10 July 2024