Delayed femoral artery injury caused by heterotopic ossification: a rare case report and review of the literature

• Published in: BMC musculoskeletal disorders Vol. 25; no. 1; pp. 485 - 7
• Main Authors: Li, Yan-Hui, Liu, Mingxi, Zhou, Chuanyang, Tan, Lei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.06.2024; BioMed Central; BMC
• Subjects: Angiography; Artery injury; Bone healing; Bone surgery; Calcification (ectopic); Care and treatment; Case Report; Case reports; Complications and side effects; Computed tomography; Computed Tomography Angiography; Diagnosis; Femoral artery; Femoral Artery - diagnostic imaging; Femoral Artery - injuries; Femoral Artery - surgery; Femoral Fractures - complications; Femoral Fractures - diagnostic imaging; Femoral Fractures - etiology; Femoral Fractures - surgery; Femoral shaft fracture; Femur; Fracture Fixation, Intramedullary; Fractures; Head injuries; Health aspects; Hematoma; Hematoma - diagnostic imaging; Hematoma - etiology; Hematoma - surgery; Heterotopic ossification; Humans; Internal fixation in fractures; Literature reviews; Male; Middle Aged; Mobility; Organization of hematoma; Ossification; Ossification (ectopic); Ossification, Heterotopic - complications; Ossification, Heterotopic - diagnostic imaging; Ossification, Heterotopic - etiology; Ossification, Heterotopic - surgery; Patient outcomes; Radiography; Risk factors; Trauma; Traumatic brain injury; Vascular System Injuries - diagnostic imaging; Vascular System Injuries - etiology; Vascular System Injuries - surgery; Veins & arteries; China; Artery injury; Organization of hematoma; Heterotopic ossification; Femoral shaft fracture
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-024-07609-5

Arterial injury caused by heterotopic ossification (HO) following fractures is rarely reported, yet it can have catastrophic consequences. This case report presents a unique instance of femoral artery injury and hematoma organization, occurring a decade after intramedullary nail fixation for a femoral shaft fracture complicated by HO. A 56-year-old male presented with right femoral artery injury and organized hematoma, a decade after suffering bilateral femoral shaft fractures with mild head injury in a traffic accident. He had received intramedullary nailing for the right femoral shaft fracture and plate fixation for the left side in a local hospital. Physical examination revealed two firm, palpable masses with clear boundaries, limited mobility, and no tenderness. Peripheral arterial pulses were intact. Radiography demonstrated satisfactory fracture healing, while a continuous high-density shadow was evident along the inner and posterior aspect of the right thigh. Computed tomography angiography identified a large mixed-density mass (16.8 × 14.8 × 20.7 cm) on the right thigh's medial side, featuring central calcification and multiple internal calcifications. The right deep femoral artery coursed within this mass, with a smaller lesion noted on the posterior thigh. Surgical consultation with a vascular surgeon led to planned intervention. The smaller mass was completely excised, but the larger one partially, as it encased the femoral artery. The inability to remove all HO was due to excessive bleeding. Postoperatively, the patient experienced no complications, and one-year follow-up revealed a favorable recovery with restoration of full right lower limb mobility. This case underscores the potential gravity of vascular injury associated with heterotopic ossification. Surgeons should remain vigilant regarding the risk of vascular injury during HO excision.