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Common femoral artery injury secondary to bicycle handlebar trauma
(Portuguese PDF version)

Coordinated by João Luiz Sandri

João Luiz Sandri¹, José Monteiro de Souza Netto², Cláudio de Melo Jacques², Bruno Bourguignon Prezotti², Giuliano de Almeida Sandri³

1. Assistant Professor, Clinical Surgery, Faculty of Sciences of Santa Casa de Misericórdia de Vitória. Vascular Surgeon, Vitória Apart Hospital.
2. Vascular Surgeon, Santa Casa de Misericórdia and Vitória Apart Hospital.
3. Medical Student, Universidade Federal do Espírito Santo.

Correspondence:
Dr. João Luiz Sandri
Av. N.S.da Penha 714/1007
CEP 29055-130 - Vitória - ES
E-mail: jlsandri@escelsa.com.br

J Vasc Br 2003;2(3):232

Part I - CASE REPORT

A 23-year-old patient fell off his bicycle and suffered handlebar trauma in the left suprainguinal region. He felt pain at the site of the trauma, and developed local ecchymosis. After that, he sought medical care at an Emergency Room, where he was examined by the duty physician.
On physical examination, no hematoma or tumor was observed in the inguinal region, only extensive ecchymosis (Figure 1).

Figure 1 - Aspect of ecchymosis of the inguinal and suprainguinal region.

The x-ray of the affected region yielded normal results. The patient was submitted to vascular surgery for evaluation, due to the presence of ecchymosis.

The physical examination showed suprainguinal ecchymosis, absence of enlarged volume or local tumor; absence of femoral and distal pulses of the left lower extremity (LLE), and left foot with a more white aspect than the right one, with more prominent difference shown by the limb elevation test. The pulses of the right lower extremity (RLE) were normal. The ankle brachial pressure index in the LLE was 0.5 and that of the RLE was equal to one. Six hours after the accident, the patient did not have local pain, but only complained of a mild discomfort at the site of the trauma.
The patient was asked to walk in the hospital corridor and he complained of discrete calf pain after approximately 100 meters. This had never occurred before the trauma.

CHALLENGE

The patient fell off his bicycle and now shows signs of vascular involvement.

" What should be done?
" What kind of trauma may have occurred?
" What exam(s) should be used to evaluate the patient?

Click here for the answer of the diagnostic challenge.