title: Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern.
abstract: During a period of six years, 765 consecutive patients were treated by the trauma service at Allegheny General Hospital for closed mid-shaft femur fractures that were a component of their injury complex. Thirty-one patients underwent angiography of the involved extremity for indications including loss of pulses in eleven and large hematomas or deformities of the thigh in the remainder. Ten patients (1.3%) were found to have acute vascular injuries. In nine patients there was an intimal flap of the superficial femoral artery (SFA), and in one, a pseudoaneurysm. Two patients had injuries of the femoral nerve. Three patients had no other associated major injuries (Injury Severity Score range, 10-19). Twelve months after the initial injury, one patient developed an arteriovenous fistula of the SFA. Detailed, repeated physical examinations, early utilization of angiography, and intensive follow-up by the trauma surgeon or orthopedic surgeon of patients with closed mid-shaft femur fractures should lead to early recognition of this potentially serious association.
authors.affiliation: Division of General Surgery, Allegheny General Hospital, Medical College of Pennsylvania, Pittsburgh 15212.
authors.forename: Y
authors.initials: Y
authors.lastname: Kluger
authors.forename: M D
authors.initials: MD
authors.lastname: Gonze
authors.forename: D B
authors.initials: DB
authors.lastname: Paul
authors.forename: D G
authors.initials: DG
authors.lastname: DiChristina
authors.forename: R N
authors.initials: RN
authors.lastname: Townsend
authors.forename: J J
authors.initials: JJ
authors.lastname: Raves
authors.forename: J C
authors.initials: JC
authors.lastname: Young
authors.forename: D L
authors.initials: DL
authors.lastname: Diamond
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D005264:Femoral Fractures / Q000150:complications* / Q000601:surgery; D005596:Fractures, Closed / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000209:etiology*