Pirrallo RG, Bridges TP. Luxatio erecta: A missed diagnosis. Am J Emerg Med 1990;8:315-7.
Musmeci E, Gaspari D, Sandri A, Regis D, Bartolozzi P. Bilateral luxatio erecta humeri associated with a unilateral brachial plexus and bilateral rotator cuff injuries: A case report. J Orthop Trauma 2008;22:498-500.
Groh GI, Wirth MA, Rockwood CA Jr. Results of treatment of luxatio erecta (inferior shoulder dislocation). J Shoulder Elbow Surg 2010;19:423-6. Access this article online Quick Response Code: Website: www.onlinejets.org
Very bad clinical aspect towards diagnosis of deep femoral artery injury: Hypovolemic shock Sir, Isolated profunda femoris artery penetrating injury is rare and has been reported as a consequence of injury, orthopedic procedures, and catheterization. In these patients, delayed diagnosis and treatment may be due to late admission to emergency department, presence of pulses on related lower limb, and also not causing arterial circulatory disorders. In our hospital, 17‑year‑old male patient with penetrating injury on left lateral part of the thigh was brought to the emergency department. After opening the external bandage, a 3 cm long skin incision was observed. In the meantime, there were no significant findings that suggestive of remarkable bleeding or 310
hematoma. On physical examination, the pulses on injured lower limb were observed. On follow‑up, deterioration of the general condition and development of patient confusion, he was urgently taken to the operating room and then lateral thigh incision was enlarged and searched source of hemorrhage. Profunda femoral vein and artery were clamped. By removing the wide injured sections on the vessels, saphenous vein graft was interposed in these segments. After an uneventful recovery, he was discharged on the 8th postoperative day. The most common cause of peripheral arterial injuries was stab and gunshot‑related injuries. The etiologies of vascular injuries especially in young males, in our country, 50-70% are gunshot injury and stab wounds.[2,3] Early diagnosis and appropriate treatment can reduce mortality and morbidity in vascular injuries. In the early period, it is difficult to diagnose profunda femoral artery injuries.[1,2] In our case, the patient had no significant bleeding when he was in the emergency department and before admission to hospital, wound area was bandaged. Hemodynamic parameters were stable but within minutes progressive hypotension and confusion were occurred and then the patient was immediately operated. False‑negative rate was 1.3% in penetrating extremity injuries with only physical examination and a 24 h observation. However, similar results have been reported by arteriography and surgical exploration (3-6%). Therefore, while no significant physical examination findings in the diagnosis of profunda femoral artery injury, clinical observation is more important.[4,5] In the vascular injuries, repair of vessels must be the first treatment option. Significant contribution to the development of collateral vessels and the lower extremity arterial circulation, the profunda femoral artery ligation is not recommended.[1‑3] In peripheral vascular diseases with diabetic and non‑diabetic, profunda femoral artery is the most considerable vessel, limb preservation of the infrapopliteal region through the nutrition with providing of collateral circulation.[4,5] As a result, in the profunda femoral artery injuries, the presence of lower limb palpable pulses, ankle/brachial index levels within normal limits, and efficient distal blood flow may hinder aiding accurate diagnosis. Consequently, performing emergency vascular access and volume replacement to patients if wound is closer to the deep femoral artery anatomy as well as estimating amount of bleeding by a detailed anamnesis, closer monitoring of the patient and we also believe that if stab wound area was bandaged, opening the bandage and establishing the presence of bleeding would be the most appropriate approach.
Faruk Cingoz, Gokhan Arslan, Erkan Kaya, Bilgehan Savas Oz Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey. E‑mail: [email protected] Journal of Emergencies, Trauma, and Shock I 6:4 I Oct - Dec 2013
Letters to Editor
Johnson CA, Goff JM, Rehrig ST, Hadro NC. Asymptomatic profunda femoris artery aneurysm: Diagnosis and rationale for management. Eur J Vasc Endovasc Surg 2002;24:91‑2.
Dennis JW, Frykberg ER, Crump JM, Vines FS, Alexander RH. New perspectives on the management of penetrating trauma in proximity to major limb arteries. J Vasc Surg 1990;11:84‑92.
Menzoian JO, Doyle JE, LoGerfo FW, Cantelmo N, Weitzman AF, Sequiera JC. Evaluation and management of vascular injuries of the extremities. Arch Surg 1983;118:93‑5.
Dennis JW, Frykberg ER, Veldenz HC, Huffman S, Menawat SS. Validation of nonoperative management of occult vascular injuries and accuracy of
Journal of Emergencies, Trauma, and Shock I 6:4 I Oct - Dec 2013
physical examination alone in penetrating extremity trauma: 5‑ to 10‑year follow‑up. J Trauma 1998;44:243‑52. 5.
Perry MO. Complications of missed arterial injuries. J Vasc Surg 1993;17:399‑407.
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