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Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 143-146

Management of shaft of femur fracture in a patient with underlying arteriovenous malformation with an intramedullary nail

Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. Praveen Sodavarapu
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/atr.atr_95_19

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We present a rare case of pathological shaft of femur fracture in an 18-year-old male, with an underlying arteriovenous malformation (AVM). Magnetic resonance imaging showed extensive intraosseous femoral involvement of the vascular malformation, and the canal was deemed to be wide enough for a nail based on the radiograph templates and computed tomography (CT) scan. The patient was given four sessions of stereotactic external beam radiotherapy preoperatively, and closed reduction and internal fixation was performed using a proximal femoral nail without any complications. Radiographic evidence of fracture union was observed at 4 months. Fracture fixation by closed reduction can be either intramedullary fixation or external fixation based on the adequacy of the canal as determined by radiograph and CT scan. Preoperative measures to decrease vascularity such as stereotactic radiotherapy and angiographic embolization can be undertaken to reduce bleeding. A multidisciplinary approach is essential to improve the management of fractures in a patient with AVM.

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