A new classification of femoral shaft fracture combined with femoral artery injury
Authors: Chi Yulei , Bu Xianmin , Li Xiaoyan , Zhang Rui , Zhang Qinming , Tian Ronghua , Xu Yingjie , Ma Fengyu , Gao Longfei , Meng Chunyang , Wang Haibin , Wu Bin 
Published: September 2020

Abstract
Background:To explore a new classification of femoral shaft fracture combined with femoral artery injury and to summarize and analyse the characteristics of various types of injury to formulate a correct early diagnosis and treatment strategy.Methods: The data of 21 patients with femoral shaft fracture combined with femoral vascular injury from December 2009 to March 2019 were analysed retrospectively, including 20 males and 1 female aged (40 ±15.5) years. The causes of injury were traffic injury (n = 16), heavy object injury (n = 3), fall injury (n = 1), crush injury (n = 1), open fracture (n = 12) and closed fracture (n = 9). The patients were classified according to whether the femoral shaft fracture was open, the location of femoral artery injury and whether it was combined with a severe multiple injury. The open femoral shaft fracture with femoral artery injury was type I, in which a similar location of fracture and vascular injury comprised type Ia, while different locations comprised type Ib. The closed femoral shaft fracture with femoral artery injury was type II, in which fracture and vascular injury at same level comprised type IIa and different levels comprised type IIb. Patients with severe multiple injuries had a type III fracture. The location of femoral shaft fracture, femoral artery injury and injury; main signs; diagnosis time; waiting time before operation; operation time; times of operations; hospitalization time; and Enneking lower limb function score were recorded.Results: According to our classification, there were 7 cases of type Ia, 4 cases of type Ib, 6 cases of type IIa, 3 cases of type IIb and 1 case of type III. The location of femoral fracture (lower segment in 7 cases, middle segment in 9 cases, proximal segment in 5 cases) and feoral artery injury (adductor tendon fissure in 12 cases, superior popliteal fossa in 7 cases, proximal deep femoral artery bifurcation in 2 cases) and the type of femoral artery injury (contusion and embolization in 3 cases, complete rupture in 18 cases) were compared. The diagnosis time for type I patients were 2.0 (1.0, 2.0) h, the preoperative waiting time was 3.5 (3.0, 5.0) h, the first operation time was 405.0 (335.0, 540.0) min, the number of operations was 2.0 (2.0, 4.0) times, the length of hospital stay was 49.0 (21.0, 71.0) days, the fracture healing time was 7.0 (5.0, 9.0) months, and the Enneking lower extremity function score was 20.0 (19.0, 22.0) points. The diagnosis time for type II patients was 7.0 (6.0, 18.5) h, the waiting time before surgery was 9.0 (8.3,20.5) hours, the first operation time was 385.0 (319.5, 490.0) min, the number of operations was 3.0 (2.0, 3.5) times, the length of hospital stay was 57.0 (29.0, 111.5) days, the fracture healing time was 6.00 (5.50, 7.50) months, and the Enneking lower limb function score was 14.0 (13.0, 15.5) points. All patients had signs of obvious weakening or disappearance of dorsal pedis artery pulsation, all type II patients had blue ecchymosis signs at the site of vascular injury, 6 patients had normal muscle strength and sensation of lower limbs, 12 patients had dorsal extension dysfunction, and 1 patient underwent thigh amputation.Conclusion: The new classification of femoral shaft combined with femoral artery injury is helpful in the diagnosis, treatment and prognosis of the injury. Generally speaking, the diagnosis time of type I injury is faster than that of type II injury, the waiting time before operation is shorter, and the prognosis of lower limb function is better. Sufficient attention should be paid to the type II injury.Weakening or disappearance of dorsal pedis artery pulsation and blue ecchymosis signs are typical signs .