AlKheraiji Abdulaziz, AlHakbani Abdulaziz
Department of Orthopedic Surgery, College of Medicine, Almajmaah University, P.O. Box 66, Almajmaah, 11952, Saudi Arabia.
Department of Orthopedics, King Saud University, College of Medicine, P.O. Box: 3643, Riyadh, 11481, Saudi Arabia.
Int J Surg Case Rep. 2020;77:695-697. doi: 10.1016/j.ijscr.2020.11.036. Epub 2020 Nov 23.
Combined femoral arterial and nerve injury does not often occur in cases of proximal femur fracture (hip fracture) and is often overlooked in the emergency medical setting. Physicians should be aware of this rare but possible combination of injuries, which can lead to devastating and disabling patient outcomes.
A 42-year-old Ethiopian male was struck by a steel pipe, rushed to the emergency room, and diagnosed with a left subtrochanteric fracture of the femur. Although promptly taken to surgery for fixation and exploration of the femoral artery, it became necessary to amputate his leg 1 week later.
Blunt injuries to the femoral nerve and femoral arterial tree are associated with high morbidity and mortality rates. These injuries should not be overlooked when diagnosing patients with blunt trauma to the femur.
When treating patients presenting with blunt trauma to the femur, several factors may obfuscate the clinician's need to perform a thorough examination of the femoral artery and femoral nerves. Among other things, the patient may not immediately present with signs of hemodynamic instability, similar to our reported case. The clinician may also be invested in treating the patient according to the Advanced Trauma Life Support protocol. When treating blunt hip trauma patients, clinicians should recognize that even blunt trauma to the femur may critically damage the femoral artery and nerve.
股动脉和神经联合损伤在股骨近端骨折（髋部骨折）病例中并不常见，在急诊医疗环境中常被忽视。医生应意识到这种罕见但可能的损伤组合，它可能导致患者出现严重且致残的后果。
一名42岁的埃塞俄比亚男性被钢管击中，被紧急送往急诊室，诊断为左股骨转子下骨折。尽管迅速接受了手术以固定并探查股动脉，但1周后仍有必要截肢。
股神经和股动脉树的钝性损伤与高发病率和死亡率相关。在诊断股骨钝性创伤患者时，这些损伤不应被忽视。
在治疗股骨钝性创伤患者时，有几个因素可能会使临床医生忽视对股动脉和股神经进行全面检查的必要性。除其他因素外，患者可能不会立即出现血流动力学不稳定的迹象，就像我们报告的病例一样。临床医生也可能专注于按照高级创伤生命支持方案治疗患者。在治疗钝性髋部创伤患者时，临床医生应认识到，即使是股骨的钝性创伤也可能严重损伤股动脉和神经。
