Introduction: Low-velocity ballistic thigh injuries can produce comminuted femoral shaft fractures with associated superficial femoral artery and vein lacerations, requiring rapid haemorrhage control and restoration of perfusion. Computed tomography angiography (CTA) provides high-resolution mapping of osseous and vascular damage, guiding the repair sequence. Case presentation: A 23-year-old man presented 1 h after a mid-thigh gunshot wound with haemorrhagic shock, expanding haematoma, and absent distal pulses. CTA revealed a comminuted femoral shaft fracture, superficial femoral artery extravasation with pseudoaneurysm, and femoral vein laceration. Emergency unilateral uniplanar external fixation stabilized the fracture. Under systemic heparinisation, proximal SFA control (anteromedial thigh) and distal popliteal control (low medial approach) were achieved. Through an entry-wound-centred incision, 1 cm full-thickness defects in both vessels were primarily repaired with interrupted 6-0 polypropylene. Reperfusion occurred after 3–4 h of warm ischaemia, including a 1-hour clamp-to-reperfusion interval, restoring distal pulses. Postoperative duplex confirmed patency. The patient received low-molecular-weight heparin prophylaxis and ceftriaxone for 10 days. External fixation was converted to intramedullary nailing at Day 30. By 8 weeks, full weight-bearing was achieved with sustained arterial and venous patency. Discussion: A staged damage-control approach, combining early skeletal stabilization with targeted dual vascular repair, minimised ischaemia and enabled definitive revascularisation in a controlled operative field. Immediate venous repair was selected given the short, clean defect and haemodynamic stability. Conclusions: This case illustrates a streamlined algorithm prioritising rapid fracture fixation and simultaneous arterial–venous repair to optimise limb salvage and functional recovery in complex ballistic thigh trauma.
Boulahroud et al. (Sun,) studied this question.