Journal of Trauma and Injury

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

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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.; Summary

Original 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

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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

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
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.2025;[Epub] CrossRef

Case Reports

Atypical Vancouver B1 periprosthetic fracture of the proximal femur in the United Kingdom: a case report challenged by myeloma, osteoporosis, infection, and recurrent implant failures: Sayantan Saha, Azeem Ahmed, Rama Mohan; J Trauma Inj. 2024;37(1):89-96. Published online March 18, 2024; DOI: https://doi.org/10.20408/jti.2023.0069

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Abstract PDF: The indications for total hip replacement are increasing and not limited to osteoarthritis. Total hip replacement may also be done for trauma and pathological fractures in patients otherwise physiologically fit and active. This trend has led to an inevitable rise in complications such as periprosthetic femoral fracture. Periprosthetic femoral fracture can be challenging due to poor bone quality, osteoporosis, and stress fractures. We present a case of periprosthetic femoral fracture in a 71-year-old woman with some components of an atypical femoral fracture. The fracture was internally fixed but was subsequently complicated by infection, implant failure needing revision, and later stress fracture. She was on a bisphosphonate after her index total hip replacement surgery for an impending pathological left proximal femur fracture, and this may have caused the later stress fracture. Unfortunately, she then experienced implant breakage (nonunion), which was treated with a biplanar locking plate and bone grafting. The patient finally regained her premorbid mobility 13 months after the last surgery and progressed satisfactorily towards bony union.; Summary

Surgical Treatment of Ipsilateral Multi-Level Femoral Fracture Treated Using Antegrade Intramedullary Nail: Beom-Soo Kim, Jae-Woo Cho, Do-Hyun Yeo, Jong-Keon Oh; J Trauma Inj. 2018;31(2):96-102. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.96

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3 Citations

Abstract PDF

Ipsilateral fractures of proximal femur with shaft and condylar region are very rare. Current concept of management is based on fixation of each fracture as independent entity using separate fixation modalities for proximal and distal parts of femur. However, we considered that antegrade femoral nailing with cephalomedullary screw fixation is a good option for ipsilateral multi-level femoral fractures. Here, we present an experience of satisfactory treatment for ipsilateral femoral neck fracture, subtrochanteric fracture, comminuted shaft fracture with supracondylar fracture following road traffic accident.

Summary

Citations

Citations to this article as recorded by

Trifocal femur fracture: Where should one begin? A case report and literature review
Gianluca Cera, Giovanni Longo, Michele Dell'Orfano, Daniele De Meo, Francesco Maria Milella, Roberta Pica, Filippo Laurenti
Trauma & Case Reports.2026; 61: 101321. CrossRef
From fracture to function: surgical management of trifocal femur fractures: a case series
Kirubakaran Pattabiraman, Anirudh Dwajan
International Journal of Research in Orthopaedics.2025; 12(1): 218. CrossRef
Multiple fractures of the femur: Case report, literature review, and proposal for a shared algorithm of treatment
Pasquale Sessa, Michele Galluzzo, Edoardo Leone, Schirò Antonio Maria, Giuseppe Giannicola
SAGE Open Medical Case Reports.2024;[Epub] CrossRef

Rare Imaging of Fat Embolism Seen on Computed Tomography in the Common Iliac Vein after Polytrauma: Hojun Lee, Jonghwan Moon, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):103-106. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.103

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Abstract PDF

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of ?86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

Summary

Citations

Citations to this article as recorded by

Fat embolism in the popliteal vein detected on CT: Case report and review of the literature
Tucker Burr, Hamza Chaudhry, Cheryl Zhang, Vasilios Vasilopoulos, Emad Allam
Radiology Case Reports.2020; 15(11): 2308. CrossRef

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