MANAGEMENT OF FEMUR FRACTURES WITH AN ASSOCIATED ARTERIAL INJURY DUE TO GUNSHOT: A REVIEW OF 12 CASES

Abstract

To determine the bony outcomes of patients treated at our Institution after sustaining femur fracture and arterial injury, due to gunshot, in the ipsilateral limb, studied over a four-year period.

The database at the Department of Vascular Surgery at our Institution was searched for cases that had sustained both arterial injury and femur fracture of the ipsilateral leg. Their case notes and X-rays were reviewed for the following:

• Time line from injury to discharge

• Procedure performed

• Duration of external fixation

• Complications (infection, iatrogenic vascular injury, amputation,

• bony union achieved)

• Incidence of fasciotomy

During the period from 2002 to the end of 2005 there were 12 patients who qualified to be included in the audit group. Three of the 12 (25%) had to undergo a primary amputation upon arrival. The other nine cases underwent surgery. One of these received an intra-medullary device, another skeletal traction and the rest external fixation following the vascular surgery. Five of the 7 external fixation devices were converted to an intramedullary device in due course. All nine cases went on to union. There were no reported cases of iatrogenic vascular repair disruption. Of the 12, only three cases reported any infection. One case developed severe osteomyelitis of the femur.

Primary vascular repair with temporary external fixation that was later converted into an intramedullary device (within 14 days) provided satisfactory results.