Limb revascularization after segmental femur fracture in children

A 10-year-old girl after a road traffic accident presented with an open displaced segmental fracture of left femur (mid-shaft and supracondylar fractures) with acute lower limb ischaemia. The leg was clinically viable. Intra-operative femoral arteriogram which performed after immediate skeletal stabilization with Kuntscher nailing and Kirschner wire fixation, showed occlusion of superficial femoral artery at mid-shaft level with good run-off. A 3 cm contused and thrombosed segment of the superficial femoral artery was excised and repaired with reversed saphenous vein interposition graft. Good distal circulation was established. Prophylactic left leg fasciotomy showed viable all three muscle compartments. She was discharged after two weeks with healed wounds and full weight bearing started after eight weeks at follow up.

Among uncommon paediatric limb injuries, femur fracture is the most common major traumatic injury in children. Flexible intra-medullary nailing or fixation with Kuntscher nails with supplementary Kirschner wires are the treatment options in case of a segmental fracture of femur in children. Peripheral vascular injuries in children are rare. Vascular injuries associated with femur fractures can give rise to devastating complications, if unrecognized, therefore require prompt early intervention. Only one case of vascular repair in children with venous interposition graft is reported in literature. Limb revascularization following segmental femur fracture in children has never been reported and requires urgent attention of radiological, orthopaedic and vascular surgical teams.