Left Femoral Artery Occlusion due to Neglected Closed Fracture Distal Femur: A Case Report
Abstract
Background: Distal femur fractures must always be considered for vascular disorders given the high risk. The incidence rate of femoral fractures is 1/10000 patients per year with the incidence rate of vascular injury around 0.10% -2.00%. Salter-Harris (SH) fracture classification is used in cases of fractures involving the growth plate (physeal plate) in children. Volkmann's ischemic contracture is caused by severe injury to the deep tissue and nerves. If tissue pressure is equal to or more than the perfusion pressure of the capillary, the microcirculation will be disrupted and ischemic occur. Normal myosit cells will be replaced by fibroblasts that tend to contract.
Subjects and Method: A 10 years old boy had a traffic accident while riding a motorcycle 6 days before the patient came to the hospital. The patient could not walk, feeling pain and swelling on the left knee, the patient didn’t bring to the hospital immediately after the accident. On physical examination, there was angulation in the distal left femur, there was tenderness on palpation and unable to do dorsiflexion or moving the fingers of the left foot but still could feel touch stimulation on the pedis.
Results: In our patient case with the diagnosis of left femoral artery occlusion et causa closed fracture distal femur (Salter-Harris type II) managed by surgery to release the femoral artery with internal fixation to the distal femur using Kirschner wire (minimally invasive) and massage to the femoral artery give optimal results.
Conclusion: Surgery to release the femoral artery with internal fixation to the distal femur using Kirschner wire (minimally invasive) and massage to the femoral artery give an optimal result.
Keywords: Salter-Harris fracture, femoral artery, Kirschner wire, Volkmann's ischaemic contracture
Correspondence: Pamudji Utomo. Department of Orthopaedics and Traumatology, Prof. Dr. R. Soeharso Orthopaedics Hospital. Email: utomodr@yahoo.com
Indonesian Journal of Medicine (2019), 4(1): 75-81
https://doi.org/10.26911/theijmed.2019.04.01.12
References
Abela CB, Vanniasinkham SH (2003). Clinical Implications of ischaemia reperfusion injury. ELSEVIER Pathophysiology. 9: 229-240. doi: 10.1016/S0928-4680(03)00025-7 Crossref PubMed Google Scholar
Ajankar VP, Panshewdikar PN, Thakre G, Mane U, Tekale V (2014). Morphological Study on Branching Pattern of Femoral Artery: A Cadaveric Study. Asian Journal of Biomedical and Pharmaceutical Sciences. 4(28): 34-38. Google Scholar
Aydin A, Topal M, Tuncer K, Senocak E (2012). Salter-Harris type III and Type IV combined fracture of the distal femoral epiphysis: A case report. Case Report In Medicine. doi: 10.1155/2012/317848 Crossref PubMed Google Scholar
Basbug HS, Gocer H, Ozisik K (2017). Huge leg hematoma due to vascular disruption following femur fracture: An Industrial Accident Catastrophe. AMAJ. 1: 12-14. doi: 10.5455/amaj.2017.01.031 Crossref Google Scholar
Cepela DJ, Tartaglione JP, Dooley TP, Patel PN (2016). Classification in brief: Salter-Harris classification of pediatric physeal fracture. Clin Orthop Relat Res. 474: 2531-2537. doi: 10.1007/s11999-016-4891-3 Crossref PubMed Google Scholar
Farzad M, Hosseini SA, Fahimi NA, Layeghi F (2010). Non surgical of established Forearm’s Volkmann contracture in child: A case report. Iranian Rehabilitation Journal. 8(11). Google Scholar
Kingori J, Gakuu LN (2010). Volkmann’s ischaemic contracture following acute compartment syndrome: A Case Report. East Africa Orthopaedic Journal. 4: 56-58. Website
Kuleta-Bosak E, Bozek P, Kluczweska E, Tomazewski R, Machnik-Broncel J (2010). Salter-Harris Type II Fracture of The Femoral Bone in a 14 Years Old Boy: Case Report. Polish Journal of Radiology. 75(1): 92-97. PubMed Google Scholar
Maheshwar L, Kiran KK, Vamshi KC, Siva PR (2015). Volkmann’s ischaemic contracture with atrophic non-union of ulna managed by bone shortening and transposition of radial autograft. Journal of Orthopaedic Case Reports. 5(1): 65-68. PubMed Google Scholar
Mayer S, Albright JC, Stoneback JW (2015). Pediatric knee dislocation and physeal fracture about the knee. J Am Acad Ortho Surg. 23: 571-580. doi: 10.5435/JAAOS-D-14-00242 Crossref Google Scholar
McKenna SM, Hamilton SW, Baker SL (2013). Salter Harris fracture of the distal femur: Learning point from 2 cases compared. Journal of Investigation Medicine High Impact Case Report. doi: 10.1177/2324709613500238 Crossref PubMed Google Scholar
Murdock M (2015). Unexpected salter-harris type II fracture of the proximal phalanx of the second toe: a Chiropractic perspective. J Can Chiropr Assoc. 59(4): 410-416 PubMed Google Scholar
Paulsen F, Washke J (2013). Sobotta Atlas Human Anatomy. Vol. 2, 15th ed., London: Urban & Fischer.
Reurings JC, Verhofstad MHJ (2007). The Volkmann ischemic contracture of the forearm is preventable. European Journal of Trauma and Emergency Surgery. 33: 539-544. doi: 10.1007/s00068-007-6142-5 Crossref PubMed Google Scholar
Smith DA, Bhimji SS (2018). Acute Arterial Occlusion. NCBI StatPearls. PubMed Google Scholar
Sperofoulos NK (2014). Classification of distal radius physeal fracture not included in the salter-harris system. The Open Orthopaedic Journal. 8: 219-224. doi: 10.2174/1874325001408010219 Crossref PubMed Google Scholar
Wind TC, Saunders SM, Barfield WR, Mooney JF, Hartsock LA (2012). Compartment syndrome after low-energy tibia fractures sustained during athletic competition. J Orthop Trauma. 26: 33-36. doi: 10.1097/BOT.0b013e3182163367 Crossref PubMed Google Scholar
Zagorac S, Lesic A, Bumbasiravic M (2016). A case of acute billateral femur frac-ture with vascular injury. Journal of Acute Disease. 5(1): 86-89. doi: 10.1016/j.joad.2015.07.009 Crossref Google Scholar
Zlotorowicz M, Czubak J (2014). Vascular Anatomy and Blood Supply to the Femoral Head. Springer. Google Scholar
Zoran B, Marija J, Daniela G, Roza DT, Jasmina N (2016). Volkmann’s contracture as a complication of supracondylar fracture of humerus in children: Case Report. SANAMED. 11(1): 57-61. doi: 10.5937/sanamed1601057B Crossref Google Scholar
