[Treatment of osteoarticular lesions associated with traumatic vascular lesions]

A critical study is made of the management of fractures associated with major vascular injuries. The pros and cons of surgical and conservative management are analyzed; it is emphasized that internal fixation, although largely used in civilian practice, is by no means necessary for successful vascular repair. The latter must be given prevalence in every instance, and an aggressive approach to the skeletal lesion is justified only in selected cases where it will not jeopardize the results of vascular repair. The therapeutic approach is analyzed step by step: selection of external or internal fixation, chronological sequence of procedures, selection of a mode of internal fixation and of a surgical approach. The different techniques of internal fixation available for upper and lower limb fractures are considered. It is concluded that the method of management of fractures associated with vascular injuries remains controversial and must be selected in every instance by a team discussion taking into account the various parameters related to both skeletal and vascular problems.