title: Early exchange intramedullary nailing of distal femoral fractures with vascular injury initially stabilized with external fixation.
abstract: Fracture of the femur with accompanying arterial injury represents approximately 1% of all femoral fractures. Controversy exists regarding the choice of fixation and the sequence of fixation and vascular repair. We report on the treatment of six patients with seven distal femoral fractures and angiographically documented arterial injuries treated over a 20-month period. The treatment protocol consisted of angiography followed by provisional external fixation and early primary exchange to an intramedullary nail. Five of the seven fractures were open. Three fractures were caused by blunt trauma, and four were secondary to shotgun blasts. Average follow-up was 12 months (range, 6-25 months). All fractures healed with an average time to union of 25 weeks. There were no complications related to the vascular repair. One case of an acute deep infection resolved after debridement and placement of polymethylmethacrylate cement beads impregnated with antibiotics and a course of intravenous antibiotics. All patients returned to their previous levels of activity. Based on the results of our experience with a small group of patients, we feel that this treatment protocol will prove to be a safe and efficient method of management of these difficult injuries.
authors.affiliation: Division of Orthopaedic Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden.
authors.forename: W M
authors.initials: WM
authors.lastname: Iannacone
authors.forename: R
authors.initials: R
authors.lastname: Taffet
authors.forename: W G
authors.initials: WG
authors.lastname: DeLong
authors.forename: C T
authors.initials: CT
authors.lastname: Born
authors.forename: R M
authors.initials: RM
authors.lastname: Dalsey
authors.forename: L S
authors.initials: LS
authors.lastname: Deutsch
mesh_terms: D000792:Angiography; D001158:Arteries / Q000293:injuries; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005592:Fracture Fixation; D005594:Fracture Fixation, Intramedullary; D005596:Fractures, Closed / Q000150:complications / Q000601:surgery; D005597:Fractures, Open / Q000150:complications / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply*; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery