Abstract
High-energy femoral fractures complicated by arterial disruption are associated with a significant risk of limb loss due to rapid distal ischemia. This systematic review evaluated the role of distal femoral bypass in limb salvage in such injuries. A literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Five studies encompassing 309 patients were included, reporting vascular repair with autologous reversed saphenous vein grafts in the context of complex femoral fractures. Due to heterogeneity in study design, interventions, and outcome reporting, a qualitative synthesis was performed. Limb salvage rates ranged from 92% to 100%, highlighting the importance of prompt revascularization coordinated with fracture stabilization. Reported complications included wound infection, graft thrombosis, bleeding, compartment syndrome, and acute respiratory distress syndrome, particularly in cases with delayed intervention or extensive soft tissue injury. Early recognition of arterial injury, timely bypass, and multidisciplinary management were critical determinants of successful outcomes. Distal femoral bypass emerges as an effective strategy for limb salvage in high-energy femoral fractures with arterial injury, though patient selection, surgical timing, and soft tissue management remain key to optimizing functional recovery.