Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2862-2869
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2862
Missed diagnosis of femoral deep artery rupture after femoral shaft fracture: A case report
Jun Ge, Ke-Yu Kong, Xiao-Qiang Cheng, Peng Li, Xing-Xing Hu, Hui-Lin Yang, Min-Jie Shen
Jun Ge, Ke-Yu Kong, Xiao-Qiang Cheng, Peng Li, Xing-Xing Hu, Hui-Lin Yang, Min-Jie Shen, Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Author contributions: Ge J and Shen MJ were responsible for the clinical management of the patient; Ge J, Li P, and Hu XX participated in selecting the related data; Ge J, Kong KY, and Cheng XQ drafted and submitted the manuscript; Yang HL and Shen MJ were major contributors to organizing and revising the manuscript.
Informed consent statement: Informed consent has been obtained from the patient to publish the information, including their photographs.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Min-Jie Shen, MD, MD, Attending Doctor, Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, No. 188, Shizi St., Suzhou 215006, Jiangsu Province, China. shenminjie@suda.edu.cn
Received: January 17, 2020
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Femoral shaft fracture, Femoral deep artery branch rupture, Perforating artery rupture, Thigh compartment syndrome, Rhabdomyolysis, External fixation, Case report

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.