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.

The effect of seatbelt legislation on hospital admissions with road traffic injuries in an oil-rich, fast-developing country.

The objective of the study was to examine the effect of seat-belt legislation on hospital admissions with road traffic injuries and was designed as a retrospective descriptive study. All motor vehicle crashes recorded during the period 2001 - 2004 were extracted from the Emergency Medical Service Department. Details of the crashes, injuries and safety devices used were studied. The present study revealed that safety belt usage rates have increased from 8% in 2001 to 67% in 2004 among patients admitted to hospital with injury after road traffic crashes. The admission rate of patients with road traffic injuries per 100 000 population reduced by 17.7%. The enforcement of the seat-belt legislation played a vital role in reduction of hospital admissions due to road traffic crashes.