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Case Report
- Iatrogenic vascular injury during retrograde intramedullary nailing of a distal femur fracture: a case report
- Jeong Seok Choi, JunHyeok Kwon, Yun Ki Ryu, Wonseok Choi, Seonghyun Kang, Jong-Keon Oh, Jae-Woo Cho
- J Trauma Inj. 2025;38(4):399-403. Published online December 31, 2025
- DOI: https://doi.org/10.20408/jti.2025.0238
- 2,344 View
- 47 Download
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Abstract
PDF - We report a case of iatrogenic injury to the lateral circumflex femoral artery following distal femoral nailing in a 72-year-old patient. Postoperatively, progressive thigh swelling developed, but initial contrast-enhanced computed tomography (CT) showed no evidence of vascular injury. The arterial injury was subsequently identified on a follow-up contrast-enhanced CT scan and was successfully treated with angiographic microcoil embolization. This case underscores the critical importance of meticulous awareness of the trajectories of the lateral circumflex and deep femoral arteries during proximal interlocking screw insertion. It also highlights that early postoperative imaging can fail to detect such vascular complications. Therefore, a high index of clinical suspicion is paramount, and repeated imaging should be strongly considered if clinical signs, such as progressive swelling, persist despite initial negative findings.
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SummaryOriginal Article
- Dual plating in the management of nonunion complex distal femur fractures following lateral locked plate fixation: radiological and functional outcomes of a prospective study
- Nilesh Barwar, Gypsy Gargi, Ankit Rai, Abhay Elhence, Sumit Banerjee, Nitesh Gahlot
- J Trauma Inj. 2025;38(2):125-136. Published online June 27, 2025
- DOI: https://doi.org/10.20408/jti.2024.0054
- 5,593 View
- 152 Download
- 2 Web of Science
- 4 Citations
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Abstract
PDF
- Purpose
Managing complex distal femur fractures presents technical challenges. Although the lateral locked plate has become standard for these fractures, failures are not uncommon when this device is used alone. Patients with nonunion of distal femur fractures following treatment with a single lateral locked plate were examined. Revision surgery was performed by applying dual plates, and their efficiency was evaluated.
Methods
This study investigated 24 aseptic and 3 septic nonunions of distal femur fractures, classified as AO/OTA type C, that were previously managed with open reduction and internal fixation using only a lateral locked plate. Revision surgery involved replacing the broken 5.0-mm lateral locked plate, supplementing the medial side with a 4.5-mm T-plate, and applying bone grafting at the fracture site. Septic cases were managed using a staged approach with dual implant application.
Results
Following revision surgery, bony union was achieved in 83.3% of aseptic nonunions, with a mean bone healing time of 22.5 weeks (range, 15–27 weeks). Additional surgery was required for the remaining 16.6%. Using staged management, the septic nonunions were united in a mean of 30.25 weeks (range, 27–32 weeks). Significant improvements were noted in the Tegner Lysholm Knee Scoring Scale, with median preoperative and postoperative scores of 30 (range, 12–67) and 80 (range, 66–90), respectively (P<0.001). Limb pain, as measured by the visual analog scale for knee pain, improved significantly from a preoperative median of 6 (range, 4–8) to 3 (range, 1–6) postoperatively (P<0.001). All patients were ambulatory without supportive devices. However, the mean knee range of motion was 80° (range, 40°–120°). Limb shortening was observed in six cases (22.2%; average shortening, 2.3±1.0 cm).
Conclusions
Dual plating appears to be an effective approach for managing failed complex distal femur fractures following initial treatment with a single lateral locked plate. -
Summary
Citations
Citations to this article as recorded by
- Paradigm Shift in the Management of Delayed Union and Nonunion of Junctional Fractures of the Lower Limb
Sushrut Babhulkar, Nitin Kimmatkar, Samir Dwidmuthe
Indian Journal of Orthopaedics.2026; 60(5): 1046. CrossRef - Does dual-plating offer superior stability in complex distal femoral fracture management?
Ahmed Naser Elbarbary, Ismail Tawfeek Badr, Emad Badawy, Rasha Yousry Kamel Saleh
Journal of Orthopaedic Surgery and Research.2026;[Epub] CrossRef - Augmented 3.5 mm plates with 3.5/4.5 mm locked plates for treating failed diaphyseal long bone fractures- the ‘Dual Plate’ Technique: A multicentric analysis of 86 neglected patients
Nishit Palo, Mahima Lakhanpal, Priti Ranjan Sinha, Abhishek Shukla, Govind Narayan Choudhary
Journal of Clinical Orthopaedics and Trauma.2026; 82: 103564. CrossRef - Nonunion in Long Bone Fractures: A Comprehensive Review of Current Treatment Strategies
Ahmed Mohamed, Daniel Francis, Usman Fuad, Nabil Elmaleh, Ahmed Nagi
Cureus.2025;[Epub] CrossRef
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