# Femoral Artery Injuries: Case Reports (graphic)



## VinT (Jun 5, 2017)

I came across a couple of videos and a publication showing some very serious femoral artery injuries. These are especially scary because they can quickly be life ending without immediate emergency care. Luckily their friends were able to save them. I thought these should be rare, but I came across two videos at random, and then two cases at a single hospital of a similar injury. So it would be good to be aware of these.

Can anyone explain how these happened? Did they hit their handlebars, or did they hit an obstacle? I've noticed some people riding with worn grips and the metal end of the handlebar exposed, so that could be safety hazard.

Other than that, I guess everyone should know basic first aid, ride with friends, have a phone and know their location coordinates.

*Graphic Warning*
Video 1 https://www.youtube.com/watch?v=w2sMFZIB6zA
Video 2 Cedric Gracia's Bloody Crash

Publication Common femoral artery injury secondary to bicycle handlebar trauma - ScienceDirect


----------



## Vegard (Jul 16, 2009)

After seeing some of these injuries I added a tourniquet to my medkit, it's not a recommended thing to do anymore. But if someone I find or myself have the option of losing a limb or losing their life it should be a pretty simple choice.


----------



## VinT (Jun 5, 2017)

Vegard said:


> After seeing some of these injuries I added a tourniquet to my medkit, it's not a recommended thing to do anymore. But if someone I find or myself have the option of losing a limb or losing their life it should be a pretty simple choice.


That's great you did that, you might save a life someday. For people who don't have that, they used a bicycle inner tube in one of the videos. I have no idea how common this is, I was shocked to see two videos when I wasn't even looking for this.


----------



## bachman1961 (Oct 9, 2013)

I did not view the links but if neither is related to an incident here in Colorado, here is a very good story / scary situation-

https://springsmag.com/rescue-almagre/


----------



## notso (Jan 22, 2015)

A rider died from a similar injury here in central VA a few years back. As he was crashing off trail he bent over a small sapling to the point that one side of the roots popped up out of the ground and one of those punctured the artery. He bled out in minutes....


----------



## VinT (Jun 5, 2017)

bachman1961 said:


> I did not view the links but if neither is related to an incident here in Colorado, here is a very good story / scary situation-
> 
> https://springsmag.com/rescue-almagre/


Thanks for sharing that. Glad he was saved.

TL;DR

* Riding alone
* Slow speed crash, steep hill
* Feet stuck clipped in
* Leg/groin hit brake lever

Thoughts
* Ride with friends
* Bring a cellphone, location info, etc
* Carry your blood type info/ID?
* Cover or replace sharp parts on your bike, especially around the handlebars?


----------



## VinT (Jun 5, 2017)

notso said:


> A rider died from a similar injury here in central VA a few years back. As he was crashing off trail he bent over a small sapling to the point that one side of the roots popped up out of the ground and one of those punctured the artery. He bled out in minutes.


That's sad. So I guess this type of accident is not a fluke, but something that happens sometimes. Maybe his injury was too severe, or he didn't have people there to help him. All the other accidents were nearly fatal, so it's probably hit or miss.


----------



## Harold (Dec 23, 2003)

I remember when that incident with Cedric Gracia happened and hit the internet awhile back. Scary ****. I don't think a tourniquet is going to be useful for a femoral artery bleed. That location is too close to your torso and you can't put the tourniquet far enough "upstream" to do the job. It works better on major bleeds more distal in places where you're essentially willing/able to sacrifice a limb to save a life.

What they did in Cedric's video, shoving a thumb inside the wound to place internal pressure on the artery, is probably the only thing that stood a chance at working, and saved his life. If he had been riding solo, or if someone in the group didn't have the ability to get help, he wouldn't have made it.


----------



## Impetus (Aug 10, 2014)

Vegard said:


> After seeing some of these injuries I added a tourniquet to my medkit, it's not a recommended thing to do anymore. But if someone I find or myself have the option of losing a limb or losing their life it should be a pretty simple choice.


Applying a tourniquet doesn't mean loss of limb. I've applied tourniquets to limbs on several occasions. It's also common practice during limb surgery, especially knee replacement. A tourniquet can stay in place for several hours before significant tissue damage begins.


----------



## ApolloMike (Nov 5, 2014)

Your chances of getting injured go up when riding with Seth. Don't ride with Seth. Just watch his videos. 


Sent from my iPhone using Tapatalk


----------



## Harold (Dec 23, 2003)

ARandomBiker said:


> Applying a tourniquet doesn't mean loss of limb. I've applied tourniquets to limbs on several occasions. It's also common practice during limb surgery, especially knee replacement. A tourniquet can stay in place for several hours before significant tissue damage begins.


It doesn't mean definite loss, but it could if it has to stay on long enough. Depends on how long it takes to get the person out.

If you gotta use one, you gotta use one.

Sent from my SM-G900V using Tapatalk


----------



## Impetus (Aug 10, 2014)

Generally the standard for tourniquet use is 4 hours, then loosen slightly for 60 seconds to allow for some re-profusion before re-tightening; then you're good for another 2-ish hours. It's a pretty rare case that evac takes more than 6 hours.
That's the protocol for most lower extremity surgeries, and the standard I taught during my time as an Army combat medicine instructor, and what I used in practice as an infantry medic during my 3 Middle East tours of combat.


----------



## WHALENARD (Feb 21, 2010)

Could you imagine? 
Falling over fatiqued in an awkward spot (we've probably all done it) and the next thing you know your brake lever has severed you femeral artery. Without immediate intervention you're going to die....gah!

This is not an issue I'm at all concerned about, though I'm no stranger to injury. How about shorts with a kevlar panel on the inner thigh?


----------



## Cayenne_Pepa (Dec 18, 2007)

notso said:


> A rider died from a similar injury here in central VA a few years back. As he was crashing off trail he bent over a small sapling to the point that one side of the roots popped up out of the ground and one of those punctured the artery. He bled out in minutes....


Yep, a guy also washed-out into a dead Manzanita tree and a brittle, stray branch went right thru his neck. His jugular drained in minutes. Man, that is what MTB nightmares are made of!!!


----------



## Harold (Dec 23, 2003)

ARandomBiker said:


> Generally the standard for tourniquet use is 4 hours, then loosen slightly for 60 seconds to allow for some re-profusion before re-tightening; then you're good for another 2-ish hours. It's a pretty rare case that evac takes more than 6 hours.
> That's the protocol for most lower extremity surgeries, and the standard I taught during my time as an Army combat medicine instructor, and what I used in practice as an infantry medic during my 3 Middle East tours of combat.


Good to know. Tourniquet use wasn't really addressed during the WFA course I took last summer. We spent more time practicing stabilizing broken limbs and potential neck injuries, and though we did spend some time talking about dealing with bleeds, we didn't talk about anything so major that it would require a tourniquet.

I still think a high femoral artery bleed isn't going to be a location where a tourniquet would be practical. Too close to the torso.


----------



## Impetus (Aug 10, 2014)

Harold said:


> Good to know. Tourniquet use wasn't really addressed during the WFA course I took last summer. We spent more time practicing stabilizing broken limbs and potential neck injuries, and though we did spend some time talking about dealing with bleeds, we didn't talk about anything so major that it would require a tourniquet.
> 
> I still think a high femoral artery bleed isn't going to be a location where a tourniquet would be practical. Too close to the torso.


Bleeds that require a tourniquet associated with biking/hiking/running are really so rare that it's barely worth mentioning in first aid courses. It's really only the military that is 'researching' it, because of the nature of the injuries (big bullets and bombs), and variable evacuation times.

Sometimes I just get really spun up because there's so much bad info out there about them, i can't help myself but to set the record straight.

I 100% agree about a femoral bleed, it's way too high for much of any intervention. The best thing you can do is jam your knee into the groin and lean hard on it to slow the bleeding, have a cell phone out and get help.


----------



## WHALENARD (Feb 21, 2010)

Perhaps a small pair of forcepts to clamp it off over tourniquet? Roach clip in a pinch.


----------



## Losvar (Mar 21, 2016)

Jam the hole full of bandages and put on a tight compress.
Do not attempt to use a tourniquet unless there's no other way, toxic shock when relieving pressure can kill people, it's not something that should be done without proper training.


----------



## levity (Oct 31, 2011)

*QwikClot*

Another approach to stopping severe bleeding is to use a clot promoting agent like QwikClot. It consists of zeolite, an aluminum silicate available in granular form or on hemostatic bandages. It's used in the military and by EMS and first responders, and I used to carry packets of Qwikclot granules on my off-road motorcycle and in my car for emergencies. MTB crashes _usually_ don't result in as much trauma and moto crashes, but I should probably carry some of the bandage dressings even when just pedaling.

Here's a video that shows just how well it works in the case of complete bisection of the femoral artery:


----------



## Cuyuna (May 14, 2017)

Handlebar injuries are pretty common but they are mostly blunt trauma. The incidence of impalement, and especially impalement leading to femoral artery bleeding would be a pretty extreme long shot. In the case of a femoral artery injury from any cause, a tourniquet would be generally useless. Quikclot...might be useful if the bleeding can't be controlled with direct pressure or by packing the wound with gauze. Blunt trauma to the femoral artery would be far more likely than penetrating trauma, but still very rare compared to the incidence of blunt trauma to the abdomen and its contents.


----------



## jaydoc (Dec 24, 2014)

ARandomBiker said:


> Generally the standard for tourniquet use is 4 hours, then loosen slightly for 60 seconds to allow for some re-profusion before re-tightening; then you're good for another 2-ish hours. It's a pretty rare case that evac takes more than 6 hours.
> That's the protocol for most lower extremity surgeries, and the standard I taught during my time as an Army combat medicine instructor, and what I used in practice as an infantry medic during my 3 Middle East tours of combat.


That's actually well over the recommended safe duration. Most surgeons/authors recommend a max of 2 continuous hours for legs, and 1.5-2h for arms, with a break of 5 min for each 30min of tourniquet use for reperfusion. This minimizes the chances of nerve injury and prolonged issues related to reperfusion injury. For injuries in the extremities, especially in the arms, direct pressure is the best for bleeding if possible as this limits the ischemia time and usually is very effective. This is especially true in injuries that will require an operation because that will provide more tourniquet time for the surgeon.

Overall though, I completely agree that a prolonged tourniquet application and the related complications beats bleeding out.


----------



## LaXCarp (Jul 19, 2008)

Cuyuna said:


> Blunt trauma to the femoral artery would be far more likely than penetrating trauma, but still very rare compared to the incidence of blunt trauma to the abdomen and its contents.


I've had blunt trauma to the abdomen due to a handlebar, I felt very grateful to have bar ends in and not core sample myself. It left a nice circule for about 3 months.

Would blunt trauma to the femoral artery potentially result in a life threatening condition that would require immediate intervention?


----------



## Cuyuna (May 14, 2017)

Blunt trauma to the groin, overlying the femoral artery (which is relatively superficial and butts up agains the pelvis) can easily damage the artery, even tear it, but that damage will generally be contained and often shows up later when the patient has leg pain from lack of blood flow. They won't bleed externally and although it may be emergent and limb-threatening, it's generally not immediately life-threatening. In this area, there is a great deal of snowmobiling, dirt-biking, 4-wheeling, and mountain-biking. We get a LOT of injuries from those activities. Handlebar injuries do occur, but they are not the most common things seen.


----------



## Chad_M (Jul 11, 2013)

Coincidence to see this thread. I was just talking to a nurse who saw this first hand a decade ago resulting in the loss of a young rider. It was a mountain bike crash with a stick going into groin region and smashing the artery. He was taken to hospital but they couldn't get bleeding under control with the amount of damage done.


----------



## Mr. Blink (Nov 26, 2017)

So, I know this thread is old AF, but I just had a fun crash over the weekend. Last week I was watching some MTB videos and saw that Cedric guy's crash, and it freaked me TF out. It can happen so easy, and so stupidly. I switched to clip ins a few weeks ago, and even though I was enjoying the upstroke power, and a little more bike control in the rear in certain situations, I was falling. A LOT. It was getting pretty annoying, so I was on the fence whether or not to switch back to platforms.

On Sunday I went riding with a buddy, and we climbed this short, steep hill. It's steep at the top. I am a single 32t in the front, and only 8 in the rear. If I keep it in 2nd and push hard I can make it up OK. Sunday I was about 3 feet from the peak, and my rear lost traction. I lost all momentum, and tried to muscle the last 1-2 pedal strokes. My bike said nope, I started rolling backwards, then tipped over to my left, kinda tumbling down an extremely steep 6 foot drop to a rocky ditch. 

There really wasn't time, or a place to clip out. I went down hard. My handlebars twisted, and my right bar end was in my sternum. The other end was pointed straight in to the ground, and when I first hit, it was like a bat to the chest. If I wasn't clipped, I could have ditched the bike. I may have eaten poop, but probably more scrapes than an epic chest punch. 

I got lucky. I think my bar ends gave the bars a lot more surface area at point of impact. Without the bar ends, I could see a very likely chest puncture situation. Needless to say, the platforms are back on the bike now. Almost looking forward to the next ride already without those scary fkin clip ins. No thank you.


----------

