[Forensic medical implications of vascular injuries in orthopedic surgery]

The vascular risk in orthopedic surgery results from the close relation between bones and vessel-nerve bundles, the use of sharp cutting and perforating instruments and, in hip surgery, the use of cement. The two main prognosis factors are early diagnosis and the time of treatment. Here we review risks by localizations. For spinal surgery, the great vessels may be damaged by discetomy and can lead to intraperitoneal bleeding and death or arteriovenous fistulization. In the scapular area, pin migrations after surgery involving the clavicle can lead to bleeding or false aneurysms of the subclavian artery. When surgery is performed for thoraco-brachial outlet syndromes, arterial damage is less frequent than nerve damage which can lead to death (one case reported) or severe sequelae. Hip surgery can damage the iliac or femoral vessels with severe sequelae after total hip replacement. Two cases of death related to femoral neck fracture and anticoagulant treatment are reported. Two other cases of lesions to the femoral artery with severe sequelae after treatment of diaphyseal fractures of the femur are also reported. In the knee area, consequences of surgery can be particularly severe, especially unrecognized damage or incorrect treatment of the popliteal artery after osteoarticular injuries, or iatrogenic lesions after knee surgery. Finally two cases of tibial artery lesions are reported. In most of these cases, medicolegal consequences were confirmed by court judgements.