BLUNT VASCULAR INJURY ASSOCIATED WITH CLOSED MIDSHAFT 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 indi cations including loss of pulses in eleven and large hematomas or defo rmities 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 pseudoane urysm. Two patients had injuries of the femoral nerve. Three patients had no other associated major injuries (Injury Severity Score range, 1 0-19). Twelve months after the initial injury, one patient developed a n arteriovenous fistula of the SFA. Detailed, repeated physical examin ations, early utilization of angiography, and intensive follow-up by t he trauma surgeon or orthopedic surgeon of patients with closed mid-sh aft femur fractures should lead to early recognition of this potential ly serious association.