Medial approach for the treatment of femur fractures in association with vascular injury.

INTRODUCTION

To highlight an alternative method of treatment for femoral fractures associated with vascular injury, allowing both fracture fixation and vascular repair from the same surgical approach.

DESIGN

Retrospective case series.

METHODS

Twelve patients with arterial injury as a consequence of femoral fracture were treated by internal fixation. There were five femoral diaphysis, seven distal femoral including supracondylar and intercondylar fractures. Four patients had injury to the popliteal artery, whereas eight to the superficial femoral artery. Seven patients had a nerve injury. Medial femoral approach was used both for the fixation of the fracture and vascular repair. Fracture fixation was done by plate-screw in all patients, whereas vascular injuries were treated using saphenous vein interposition graft in ten patients and end-to-end repair in two patients. Nerve injuries were not dealt by exploration during the vascular repair.

RESULTS

All of the limbs were ultimately survived. Clinical and radiological union was observed in all patients at the last follow-up radiographs. Of the 4 total sciatic nerve palsies, 2 had developed total, one had tibial nerve recovery. One patient had no motor recovery. Of the 3 peroneal nerve palsies, 1 patient had recovery, 2 patients had no motor improvement.

CONCLUSIONS

A midlateral approach is traditionally used for fractures of femur when plates and screws are used for fixation. In association with vascular injury, this procedure requires two separate incisions. The added soft tissue disruption associated with open reduction and internal fixation by lateral incision can be reduced with the use of single medial approach, which allows bony stabilization under direct visualization of the repaired vessels.