title: Location of civilian ballistic femoral fracture indicates likelihood of arterial injury.
abstract: BACKGROUND
  We evaluated whether the location of a ballistic femoral fracture helps predict the presence of arterial injury. We hypothesized that fractures located in the distal third of the femur are associated with a higher rate of arterial injury.
  
  
  METHODS
  We conducted a retrospective review of electronic medical records at our level I trauma centre and found 133 consecutive patients with femoral fractures from civilian gunshots from 2002 to 2007, 14 of whom sustained arterial injury. Fracture extent was measured with computerized viewing software and recorded with a standard technique, calculating proximal, distal, and central locations of the fracture as a function of overall length of the bone. Analyses were conducted with Student's t, Chi-squared, and Fisher's exact tests.
  
  
  RESULTS
  The location of any fracture line in the distal third of the femur was associated with increased risk of arterial injury (P<0.05). The odds ratio for the presence of arterial injury when the proximal fracture line was in the distal third of the femur was 5.63 (95% confidence interval, 1.7-18.6; P<0.05) and when the distal fracture line was in the distal third of the femur was 6.72 (95% confidence interval, 1.78-25.44; P<0.05).
  
  
  CONCLUSIONS
  A fracture line in the distal third of the femur after ballistic injury is six times more likely to be associated with arterial injury and warrants careful evaluation. Our data show that fracture location can help alert clinicians to possible arterial injury after ballistic femoral fracture.
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: Leah
authors.initials: L
authors.lastname: Gitajn
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Perdue
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States.
authors.forename: John
authors.initials: J
authors.lastname: Hardcastle
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: rvo3@yahoo.com.
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
mesh_terms: D000328:Adult; D000792:Angiography; D003161:Compartment Syndromes / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D005260:Female; D005264:Femoral Fractures / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010808:Physical Examination; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D057772:Vascular System Injuries / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014948:Wounds, Gunshot / Q000150:complications* / Q000473:pathology / Q000601:surgery
keywords: Arterial injury; Ballistic femoral fracture