Vascular injuries associated with fractures of the femur.

Over a five-year period, 21 patients were seen with vascular injuries associated with fractures of the femur. In 19, vascular repair was performed at the time of the acute injury. The average interval from injury to repair was 15 hours. Arterial injuries included transection, intimal flap, laceration, avulsion, and false aneurysm. End-to-end repair was done in 11 cases, and autogenous vein grafting in nine. One artery was ligated for false aneurysm. In the 19 acute cases, internal fixation was used in eight; this method of immobilization resulted in two major amputations and three cases of anterior tibial compartment necrosis. Of 11 patients who had external immobilization, two eventually required amputation because of massive soft tissue injury. Internal bone fixation is not necessary for successful vascular repair and seemed to cause greater limb and tissue loss, probably due to prolonged ischemia time. If internal bone fixation is used, the artery should be repaired before the bone.