title: Changing patterns of arterial injuries associated with fractures and dislocations.
abstract: BACKGROUND
  Significant changes occurred over a 4.5-year period in the causes, diagnosis, and treatment of arterial injuries associated with skeletal fractures of the extremities.
  
  
  METHODS
  The trauma registry data of 1,091 consecutive patients with fractures, dislocations, or both, were reviewed for the diagnosis of associated arterial injury documented by arteriography or an exploratory operation. The decision to perform a vascular repair was based solely on the presence of definitive signs of arterial injury found during physical examination.
  
  
  RESULTS
  Arterial injuries occurred in 41 patients (3.8 percent). Of these, 29 (71 percent) had penetrating injuries, and 12 (29 percent) had blunt trauma. Twenty-six patients (63 percent) had definitive signs of arterial injury and all required arterial repairs. Only three patients (7.3 percent), all with blunt injuries, required amputations because of massive soft tissue trauma. Fifteen patients had intimal flaps, irregularities, or localized narrowings shown on the arteriogram. No patient's condition had deteriorated by the time of a repeat arteriogram (n = 6) or physical examination (n = 9), and no injury required delayed repair (mean follow-up of 6.5 months). No patient without definitive signs of vascular injury at the time of initial examination required surgical repair.
  
  
  CONCLUSIONS
  Arterial injuries associated with fractures increasingly result from penetrating trauma and carry a much lower risk of amputation than injuries from blunt trauma. Physical examination can accurately detect 100 percent of the arterial injuries requiring repair. Minimal arterial abnormalities seen on arteriograms may be safely followed up by observation.
authors.affiliation: Department of Surgery, University of Florida Health Science Center at Jacksonville 32209, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Atteberry
authors.forename: J W
authors.initials: JW
authors.lastname: Dennis
authors.forename: F
authors.initials: F
authors.lastname: Russo-Alesi
authors.forename: S S
authors.initials: SS
authors.lastname: Menawat
authors.forename: B J
authors.initials: BJ
authors.lastname: Lenz
authors.forename: E R
authors.initials: ER
authors.lastname: Frykberg
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D001158:Arteries / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications*; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery