Femoral artery intimal injury following open reduction of an acetabular fracture.

Vascular injury is a devastating complication of internal fixation of acetabular fractures. While lacerations of the large vessels may lead to massive bleeding, they are obvious and are addressed immediately during the surgery. We encountered a subtle case of intimal injury and thrombosis of the femoral artery. A 20-year-old man presented with a fractured right acetabulum and right fourth, fifth, and sixth ribs with hemopneumothorax after a high-velocity motor vehicle accident. Twelve days after the injury, open reduction and internal fixation of the acetabular fracture from an ilioinguinal approach was performed. Postsurgically, examination showed no palpable femoral arterial pulse distal to the inguinal ligament. Exploration of the common femoral artery showed arterial thrombus, which was removed by a Fogarty catheter; however, the pulselessness persisted. Further exploration revealed intimal injury of the femoral artery. Replacement of the damaged segment by an interpositional venous graft was performed and peripheral pulses were reestablished. The patient recovered uneventfully. Extreme care should be taken to avoid vascular injury in pelvic fracture surgery. Meticulous surgical technique, particularly in the middle window, is vital to minimizing the risk of this complication. The insidious nature of the intimal arterial injury underlines the necessity of close intraoperative and postoperative monitoring of limb vascularity to detect such vascular lesions immediately and prevent this potentially disastrous complication.