Rare popliteal mass following retrograde nailing of ballistic femur fracture: a case report

Abstract

Introduction: Civilian ballistic injuries are commonly associated with fracture, vascular injury, and soft tissue trauma. Posttraumatic pseudoaneurysms represent an extremely rare subset of vascular injuries following ballistic fractures.

Case: We present the rare case of a posttraumatic pseudoaneurysm that occurred after retrograde femoral nailing of a ballistic distal femur fracture. The patient presented in clinic postoperatively with a pulsatile popliteal mass. Distal pulses were intact but subsequent ultrasound and angiography revealed a pseudoaneurysm of the distal superficial femoral artery. The pseudoaneurysm was subsequently treated with a covered stent and the patient's recovery was uncomplicated.

Conclusion: Due to the potential life and limb-threating complications from pseudoaneurysm rupture, this case report emphasizes the early recognition and expeditious management of vascular complications following ballistic fractures in the civilian population.

Keywords: ballistic injury; civilian; femur fracture; pseudoaneurysm; retrograde femoral nail; traumatic.

Figure 1

Comminuted left distal femur status post gunshot wound.

Figure 2

Two weeks status post retrograde nailing of ballistic distal femur fracture.

Figure 3

CT angiogram 2 months postop showing large pseudoaneurysm (left, red circle) and significant shrapnel (right, red circle).

Figure 4

Intraoperative angiogram demonstrates pseudoaneurysm from superficial femoral artery (SFA) (arrow, left). A coated stent is deployed (middle) with successful restoration SFA flow (right).