Vascular injury with associated bone and joint trauma

The clinical presentation and management of 102 vascular injuries associated with bone and joint trauma, in 100 patients over a 6-year period, is reviewed. Eighty-three injuries involved the lower limbs. Amputation became necessary in 16 patients. In 12 this was directly attributable to delay in revascularization or the extent of the soft tissue injury with consequent sepsis. Early graft occlusion in an otherwise salvageable limb occurred in four patients (3.9 per cent). Successful therapy involves close co-operation between vascular and orthopaedic surgeons with the vascular injury taking priority. The orthopaedic injury should be treated on its merits. In contaminated or comminuted fractures skeletal traction (or in suitable cases exoskeletal fixation) can be employed without adversely affecting the vascular repair. A plea is made for early diagnosis of concomitant vascular injury in patients with bone and joint injuries; this depends on clinical awareness and careful and repeated examination.