Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern.
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.
Kluger
Y
Y
Division of General Surgery, Allegheny General Hospital, Medical College of Pennsylvania, Pittsburgh 15212.
Gonze
M D
MD
Paul
D B
DB
DiChristina
D G
DG
Townsend
R N
RN
Raves
J J
JJ
Young
J C
JC
Diamond
D L
DL
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*