TREATMENT OF FEMUR FRACTURE WITH ASSOCIATED VASCULAR INJURY

Objective: The aim of this study was to determine (1) if internal fixa tion was associated with a high amputation rate in patients with femur fracture and vascular injury; and (2) if patients who underwent inter nal fixation before vascular repair had a higher amputation rate. Desi gn: This is a retrospective analysis. Materials and Methods: Twenty-si x patients requiring femoral stabilization with injury to the superfic ial femoral artery, popliteal artery, or common femoral vein were stud ied. The Injury Severity Score and the Mangled Extremity Severity Scor e were calculated for each. Nineteen patients underwent internal fixat ion. Ten patients had internal fixation before vascular repair. Result s: Sixteen of 19 patients treated with internal fixation had limb salv age. Nine of 10 patients who had internal fixation before vascular rep air had limb salvage, Poor outcomes (gangrene, amputation, or death) w ere associated with a Mangled Extremity Severity Score greater than or equal to 6 (p = 0.005). Conclusions: In these patients, poor outcome is associated with severe leg injury, (with a Mangled Extremity Severi ty Score of greater than or equal to 6). Internal fixation can be safe ly used, and skeletal stabilization can be safely performed before vas cular repair, If ischemic time is prolonged, vascular shunts should be used until skeletal stabilization is completed.