Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2862
Peer-review started: January 17, 2020
First decision: March 27, 2020
Revised: May 24, 2020
Accepted: June 20, 2020
Article in press: June 20, 2020
Published online: July 6, 2020
Processing time: 171 Days and 20.3 Hours
Vascular injury is a rare complication of femoral shaft fractures, and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms. Despite its low incidence, deep femoral artery rupture can lead to life-threatening outcomes, such as compartment syndrome, making early identification and diagnosis critical.
A 45-year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident, with complaints of severe pain and swelling on his right thigh. X-ray demonstrated a right femoral shaft fracture. During preparation for emergency surgery, his blood pressure and blood oxygen saturation dropped, and sensorimotor function was lost. Computed tomography angiography was performed immediately to confirm the diagnosis of rupture of the deep femoral artery and compartment syndrome, so fasciotomy and vacuum-assisted closure were performed. Rhabdomyolysis took place after the operation and the patient was treated with appropriate electrolyte correction and diuretic therapy. Twenty days after the fasciotomy, treatment with the Hoffman Type II External Fixation System was planned, but it was unable to be immobilized internally based on a new esophageal cancer diagnosis. We kept the external fixation for 1 year, and 3 years of follow-up showed improvement of the patient’s overall conditions and muscle strength.
For patients with thigh swelling, pain, anemia, and unstable vital signs, anterior femoral artery injury should be highly suspected. Once diagnosed, surgical treatment should be performed immediately and complications of artery rupture must be suspected and addressed in time.
Core tip: We present a case of deep femoral artery injury in a patient with femoral fracture, which was very surprising considering the anatomical position of the deep artery, with the lower position of the femoral shaft fracture being compared to the hip fracture. In addition, for doctors, the possibility of diagnosing arterial rupture based on the non-specific symptoms of arterial rupture is much greater, which tends to cause a missed diagnosis. In addition, this case also introduces the treatment of life-threatening complications and feasible surgical techniques after arterial rupture.