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Case Presentation

A case of a young male, restrained passenger who was involved in a rollover motor vehicle crash. A metal road sign pole was impaled through and through his right lower extremity.


Impalement through right thigh

He was taken to OR with a shattered femur and transected superficial femoral artery and vein. After removing the sign post, we ligated his superficial femoval vein and placed a temporary shunt in the artery between the superficial femoral and popliteal arteries. Orthopaedics then plated his femur. and we then performed a bypass of his superficial femoral artery with contralateral greater saphenous vein.


Shunt in superficial femoral artery

He was able to ambulate with a functional limb post operatively and did surprisingly well!

Discussion & References

For discussion and references on the management see the articles on Combined Skeletal & Vascular Injury and Damage Control Surgery

Submitted by: Richard Koehler, Steve Merrell

Comments

On 07/10/2007, Dr.Suhail yaqoob commented:

Good job done.Kindly specify the nature of ur temporary shunt and what handy alternatives do u suggest with the precautions if any.

On 09/14/2007, sarfile commented:

How long it takes to graft the femoral artery ?
what about maceration of tissues ? how long it takes to heal? is he able to bend or use his knee? thanks for enlightening

On 12/26/2007, christine horman commented:

my question is,did this patient have to under go extensive physical therapy? it would seem as if after such a traumatic injury of that magnatude,there would be at least some permenant damage to limit use of his limb..christine horman

On 11/22/2011, John Leslie commented:

My question is - were this to occur in a remote (but not third world)  location without orthopaedic or vascular specialist available, would it be best to transport the patient with the sign in situ to an appropriate specialist facility?  What time issues are there?

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