A femoral arteriogram was performed on a patient with a healed fractured femur that had been treated with external fixation. The arteriogram showed normal arterial flow and excluded any compression or damage to the arteries from the external fixation placement. Placement of external fixation carries a risk of inadvertently injuring blood vessels. Careful assessment of pin placement and vascular exams before and after surgery are important to detect any unrecognized vascular injuries early.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Normal Femoral Arteriography in
a Patient with Fracture Femur
and External Fixation
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. The Case
 The subsequent pictures were
obtained from a short movie of right
femoral arteriogram performed
through a percutaneous trans-left
femoral Seldinger technique for a
patient with a healed fracture
femur treated by external fixation
(EF). The test was performed to
exclude an arterial compression or
damage due to EF placement and
proved to be normal.
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12. Comment
 “Placement of external fixation
frames is an expedient and minimally
invasive method of achieving bone
and joint stability in the setting of
severe trauma. Although anatomic
safe zones are established for
placement of external fixation pins,
neurovascular structures may be at
risk in the setting of severe trauma”
[1]. 12

13. Comment…
 “Careful assessment of external fixator pin
placement is crucial to avoiding iatrogenic
injury. A thorough vascular examination
pre-operatively and prior to leaving the
operating room is recommended, which
allows any abnormalities to be further
evaluated while the patient remains in a
controlled environment. When an
unrecognized iatrogenic injury occurs,
serial postoperative neurovascular
examinations allow early recognition and
corrective actions” [1].
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14. Comment…
 “The femoral artery anatomy has been
thoroughly studied and safe zones for femoral
external fixator pin placement have been
established” [1].
 “Rates of vascular injury after skeletal
external fixation are unknown; however,
there are multiple case reports in the
literature highlighting this potentially
devastating complication. Vessel injury has
been described secondary to direct or partial
laceration, indirect compression and
impingement, and erosion” [1].
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15. ● Bibliography
[1] Staeheli GR, Fraser MR Jr, Morgan SJ.
The dangers of damage control
orthopedics: a case report of vascular
injury after femoral fracture external
fixation. Patient Saf Surg. 2012 Mar
26;6:7. doi: 10.1186/1754-9493-6-7. PMID:
22443812; PMCID: PMC3340320.
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