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.

Conclusion: 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.

Figure 1

Patient with low velocity gunshot injury to distal femur with vascular injury treated with vascular repair followed by fasciotomy of the leg followed by retrograde femoral nailing. (A, B) Anteroposterior and lateral X‐rays showed distal femoral fracture. The patient was also found to have a superficial femoral arterial injury. Photographs showing prophylactic fasciotomy with medial (C) and lateral (D) dual incisions done after vascular repair demonstrated significant muscle bulging, likely indicative of the development of compartment syndrome. The muscle tissue, however, was viable. (E, F) X‐rays one year after operation demonstrated femoral fracture healed with a retrograde femoral nail in place. Multiple vascular clips were also noted.