title: Gunshot femoral fractures with vascular injury: a retrospective analysis.
abstract: OBJECTIVE
  To retrospectively investigate the experience at one urban level one trauma center with gunshot femoral fractures with vascular injury and to examine the implication of surgical sequence with regards to short-term complications and ischaemia time.
  
  
  METHODS
  We performed a retrospective study of 24 patients treated at an urban level one trauma center over a 10-year period with low velocity gunshot wounds resulting in femur fractures and major vascular injury. Data were stratified according to sequence of surgical intervention.
  
  
  RESULTS
  The mean age was 31.3 years. Mean time to revascularization was highest in patients undergoing definitive orthopaedic fixation first (660 min) and lowest in patient undergoing shunting first (210 min). Most complications in patients undergoing vascular repair first, included two disrupted repairs requiring immediate revision after subsequent orthopaedic fixation. Other complications included compartment syndrome and one amputation.
  
  
  CONCLUSIONS
  Surgical sequence did not appear to impact the outcome with regard to limb loss, compartment syndrome, or mortality. Orthopaedic repair following vascular repair, however, is a risk for disruption of the vascular repair. We suggest that close and early direct communication between the orthopaedic and vascular surgeons take place in order to facilitate a satisfactory outcome.
authors.affiliation: Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, PA 19140, USA. saqib.rehman@tuhs.temple.edu
authors.forename: Saqib
authors.initials: S
authors.lastname: Rehman
authors.forename: Nima
authors.initials: N
authors.lastname: Salari
authors.forename: Paul
authors.initials: P
authors.lastname: Codjoe
authors.forename: Mahin
authors.initials: M
authors.lastname: Rehman
authors.forename: John
authors.initials: J
authors.lastname: Gaughan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000150:complications / Q000601:surgery*; D014948:Wounds, Gunshot / Q000601:surgery*; D055815:Young Adult