Orthopedic trauma of limbs associated with vascular injuries.
OBJECTIVE
To evaluate the treatment for patients with major vascular injuries associated with traumatic orthopedic injuries.


METHODS
A total of 196 patients, aged from 4-67 years with the mean age of 29.88 years, had major vascular injuries associated with traumatic orthopedic injuries and were treated in our hospital in a period of 44 years. The most common mechanism of trauma was blunt trauma (67.3%), open injuries accounted for 32.4% and 54.5% of the injuries were located in the lower extremities. The vascular injury frequently happened in the femoral artery (26.7%) and popliteal artery (20.3%). The treatment principle consisted of aggressive resuscitation, Doppler imaging and stable bone internal fixation with subsequent vascular repair and debridement. The vascular repair for injuries included end-to-end anastomosis (80 cases, 39.6%), interpositional vein graft (94, 46.5%), vascular decompression through fracture distraction (18, 8.9%), arterial ligation (6, 3.0%), vein patch (2, 1.0%), bypass graft (2, 1.0%), venous repair including autogenous vein graft (9, 24.3%) and ligation (28, 75.7%) and prophylactical fasciotomy (15, 7.4%). Postoperative amputation was performed in 16 cases (16.3%).


RESULTS
No intraoperative death was observed and all fractures united within 6 months. Limbs were salvaged in 180 patients (91.8%). Among these patients, early complications were found in 19 patients (9.7%) and late complications were observed in 8 patients (4.1%).


CONCLUSIONS
A well-organized approach, based on a specific treatment principle, not only improves clinical outcome but also does good to excellent functional recovery for patients with severe orthopedic injuries and concomitant vascular lesion.
Institute of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China. jiqiang@fmmu.edu.cn
Qiang
Q
Jie
Liu
L
Yang
Qing-sheng
QS
Zhu
Ming-quan
MQ
Li
Zhao
Z
Li
Guang-yue
GY
Zhao
Yun-yu
YY
Hu
D000293:Adolescent; D000328:Adult; D001808:Blood Vessels / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications*; D005597:Fractures, Open / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies