Principles in the management of arterial injuries associated with fracture/dislocations

Ten out of 355 patients admitted with fracture and/or dislocations of long bones secondary to blunt trauma had associated vascular injuries. The clinical recognition of the associated vascular injury and its vertification of arteriography, Doppler study or surgical exploration resulted in early vascular repair and limb salvage. The controversial aspects of bone stabilization followed by vascular repair versus primary vascular repari, skeletal traction and delayed internal fixation together with fasciotomy-fibulectomy are discussed. Our results with the injuries seen justify the principle of bone stabilization followed by vascular repair, particularly since a team effort resulted in little time lost prior to circulatory restoration. The problems following vascular repair-namely anterior compartment snydrome, acute renal failure and cardiac arrest are present with their principles of management.