Factors determining outcome in fractures of the extremities associated with arterial injuries

Fifteen patients with fractures of the extremities and associated arterial injuries treated from 1976 to 1987 were retrospectively analyzed. Complete ischemia was present in only two cases; in four cases with partial ischemia, the vascular injury presented late after 12 h-14 days. All limbs could be preserved, but complications were frequent and necessitated 28 operations. Complications were less frequent in primary external fixation of lower-extremity lesions compared with internal fixation. Normal function was regained only in closed fractures or in the absence of discontinuous nerve lesions. It is concluded that short-term salvage of these severe combined injuries depends on the degree and duration of deficient perfusion, but the mid- to long-term functional result depends on the severity of skin, muscle, bone, and nerve injury. The high salvage rate is attributed to the short delay to arterial reconstruction in complete ischemia and the restoration of circulation in isolated tibial artery injuries in partial ischemia cases.