title: Vascular injury associated with extremity trauma: initial diagnosis and management.
abstract: Vascular injury associated with extremity trauma occurs in <1% of patients with long bone fracture, although vascular injury may be seen in up to 16% of patients with knee dislocation. In the absence of obvious signs of vascular compromise, limb-threatening injuries are easily missed, with potentially devastating consequences. A thorough vascular assessment is essential; an arterial pressure index <0.90 is indicative of potential vascular compromise. Advances in CT and duplex ultrasonography are sensitive and specific in screening for vascular injury. Communication between the orthopaedic surgeon and the vascular or general trauma surgeon is essential in determining whether to address the vascular lesion or the orthopaedic injury first. Quality evidence regarding the optimal fixation method is scarce. Open vascular repair, such as direct repair with or without arteriorrhaphy, interposition replacement, and bypass graft with an autologous vein or polytetrafluoroethylene, remains the standard of care in managing vascular injury associated with extremity trauma. Although surgical technique affects outcome, results are primarily dependent on early detection of vascular injury followed by immediate treatment.
authors.affiliation: Department of Orthopaedic Surgery and Rehabiltation, Wake Forest University Baptist Health, Winston Salem, NC, USA.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Halvorson
authors.forename: Adam
authors.initials: A
authors.lastname: Anz
authors.forename: Maxwell
authors.initials: M
authors.lastname: Langfitt
authors.forename: Joel K
authors.initials: JK
authors.lastname: Deonanan
authors.forename: Aaron
authors.initials: A
authors.lastname: Scott
authors.forename: Robert D
authors.initials: RD
authors.lastname: Teasdall
authors.forename: E A
authors.initials: EA
authors.lastname: Carroll
mesh_terms: D000465:Algorithms; D000671:Amputation, Surgical; D000792:Angiography; D001807:Blood Vessel Prosthesis; D003299:Cooperative Behavior; D004630:Emergencies; D005121:Extremities / Q000098:blood supply*; D005592:Fracture Fixation / Q000379:methods; D005597:Fractures, Open / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D033183:Interdisciplinary Communication; D004204:Joint Dislocations / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D023821:Limb Salvage; D010348:Patient Care Team; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D014680:Veins / Q000637:transplantation
chemical_list: D011138:Polytetrafluoroethylene