Treatment of vascular injuries associated with limb fractures

INTRODUCTION The goal of therapy in all patients with combined orthopaedic and vascular injuries of the extremities is salvage of a functional limb. In this study, we have evaluated our experience with a subset of patients who had a combination of vascular injury and limb fracture. PATIENTS AND METHODS The records of 192 patients with vascular injuries of the lower and upper limbs associated with bone fractures were reviewed. Of these, 168 were males and 24 were females; the mean age was 26 years. RESULTS The mechanism of injury was a penetrating wound in 97 (51%) patients and blunt trauma in 95 (49%) patients. Injured vessels included 6 subclavian/axillary, 39 brachial, 14 radial/ulnar, 11 radial, 8 ulnar, 36 femoral, 43 popliteal, 35 tibial arteries. Saphenous vein graft was the most common conduit of choice in arterial repair (55%). Amputations were needed for 20 patients. The limb salvage rate was 88%. Three patients died. CONCLUSIONS This study established that delay in surgery, blunt trauma and extensive soft tissue defect in combined orthopaedic and vascular injuries are associated with increased risk of amputation.