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Fractures with Arterial Injury

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European Surgical Orthopaedics and Traumatology

Abstract

The potential for serious vascular injury in fractures is related to the site and mechanism of skeletal injury. The vasculature of the extremities is vulnerable to trauma in fractures of the skeleton, primarily because of the proximity of the vessels to the bones, their fixed placement around the joints, and their superficial position. Thus, vascular injury should be anticipated with fractures and/or dislocations in vulnerable anatomical areas, such as the knee, elbow and shoulder. Fractures with arterial lesions run a high risk for muscle necrosis, partial or complete amputation, or loss of extremity function. In order to maximise outcome, it is paramount that the surgeon recognises the implications of the potential or actual vascular injury. Although open fractures run the greatest risk of being combined with an arterial injury, closed fractures may also be associated with a significant vascular lesion. Survival or not of a limb with combined bony and vascular damage is closely related to the severity of the injury and the timely diagnosis and treatment of the vascular trauma. An important factor in the prognosis of fractures with arterial lesions is ischaemia time. Rapid and proper patient transport, with a subsequent decrease in warm ischaemia time are critical factors in decreasing the rate of amputation. Measurements with Doppler or duplex ultrasonography are valuable adjuncts in the rapid evaluation of patients with traumatic arterial injury. When unequivocal evidence of arterial injury is present, and the operative approach is established by the mechanisms and site of injury, treatment should not be delayed by confirmatory arteriography. To avoid detrimental sequelae, it is better for the surgeon to presume a fracture is complicated by vascular or nerve injury until proven otherwise.

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Authors and Affiliations

  1. School of Medicine, University of Athens, Sofokleous Str #13, Athens, 14671, Greece

    Panayotis N. Soucacos

  2. School of Medicine, University of Athens, 1 Rimini Str, 12462, Haidari, Athens, Greece

    Zinon T. Kokkalis

Authors
  1. Panayotis N. Soucacos
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  2. Zinon T. Kokkalis
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Correspondence to Panayotis N. Soucacos .

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Editors and Affiliations

  1. Royal National Orthopaedic Hospital, Stanmore, United Kingdom

    George Bentley

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Soucacos, P.N., Kokkalis, Z.T. (2014). Fractures with Arterial Injury. In: Bentley, G. (eds) European Surgical Orthopaedics and Traumatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34746-7_19

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  • DOI: https://doi.org/10.1007/978-3-642-34746-7_19

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  • Publisher Name: Springer, Berlin, Heidelberg

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  • Online ISBN: 978-3-642-34746-7

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