This document presents two cases of femoral artery injury associated with femur fractures. The first case involved a young male who had irreversible ischemia in his right leg due to a missed arterial injury. He ultimately lost his limb. The second case involved another young male with a comminuted left femur fracture. Surgical exploration revealed no arterial injury but fasciotomy of the calf saved the limb. The take home messages are that early surgical exploration is important to rule out arterial injuries when angiography is unavailable, and fasciotomy is an important procedure to relieve compartment pressure in vascular injuries of the extremities.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Femoral Artery Injury Associated
with Fracture Femur: Don’t Miss
the Vascular Injury
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. The Cases
 Herein, we present 2 cases of fracture
femur with suspicion of associated
vascular injuries in 2 young adult male
patients who received different
managements resulting in unfortunate
limb loss in the 1st case and salvaged
limb in the 2nd case. Both cases were
managed in Sulaymaniyah Teaching
Hospital (STH), Sulaymaniyah, Region
of Kurdistan, Iraq in the year 2010. The
presentation ends with important take
home messages. 2

3. Case 1
 A young adult male patient was referred to
STH from Kirkuk (95 km from
Sulaymaniyah) with an irreversible
ischaemia of right leg. He had sustained a
blunt trauma a few days ago which caused
a fracture of his right femur. Besides the
referring letter, there was a Doppler US
report indicating a “low flow in the
popliteal artery, a very weak flow in the
posterior tibial artery and absent flow in
the dorsalis pedis artery suggesting an
arterial injury”. 3

4. Irreversible ischaemia
of the right leg
4

5. Fracture right femur
5

6. 6

7. Case 2
 A young adult male patient presented with
comminuted fracture of left femur following
a road traffic accident. On examination, the
limb was viable but the leg was tense (acute
compartment syndrome). We decided to
explore the femoral artery for suspicion of
its injury. Exploration revealed no vascular
injury. Moreover, fasciotomy of the calf was
performed and the calf muscles were viable.
The fracture was managed by external
fixation. The outcome of the limb was very
good. 7

8. 8

9. 9

10. 10

11. 11

12. Comment
 Unfortunately, the first case was beyond
salvage when received in our hospital.
The referral was too late.
 Although surgical exploration of the
femoral vessels in the second case was
negative, it was the only way to rule out
vascular injury in the setting of lack of
angiography.
 Similarly, fasciotomy relieved the
compartment compression in the 2nd case.
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13. Take Home Message
 In cases of orthopaedic injuries
(fracture and/or dislocation) with
suspicion of arterial injury, early
surgical exploration is mandatory
particularly when angiography is not
available to make the diagnosis.
 Fasciotomy is a very important
adjuvant operation in vascular injuries
of the extremities.
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