Diagnosis and management of vascular injuries associated with skeletal trauma

The circulatory status of the extremity distal to skeletal trauma is evaluated routinely, but the implications of subtle physical findings are not always clear. Abnormal clinical findings associated with a fracture or dislocation near a major vessel often warrant intraoperative, "one-shot" angiography. Close cooperation between the orthopaedic and vascular teams is essential to ensure adequate revascularization within six hours of injury. Fracture fixation is usually performed first, using the method dictated by the fracture pattern and the nature of the soft-tissue damage. Fasciotomy should be performed in almost all cases.