Lower limb fractures with an associated vascular injury are a challenging management problem for the orthopedic and vascular surgeon. The effect of an associated vascular injury on fracture healing has not been enlightened much. Functional outcome following lower extremity vascular injury when assessed through limb salvage rates underestimates the of functional disability of the survived limb.
Methods: We studied 36 patients with fracture/dislocation of the long bones of lower limb with vascular injury, where in the limb was salvaged, between June 2009 to June 2012. Information regarding the mangled extremity severity score, ISS, revised trauma score, presence of circulatory, motor, sensory deficits was assessed. 8 patients had femur fracture with injury to the femoral artery, 28 patients had tibia & with injury to either popliteal artery, anterior or posterior tibial artery. All patients underwent vascular repair & skeletal fixation in the form of external fixator initially flap when required.
Results: From 2008-2011, 36 patients were studied. The mean age 35. A total of 6 patients had an amputation performed post vascular repair at a later date. Patients requiring amputation were significantly older than those without amputation. Fractures with an associated injury to the posterior tibial artery had a significantly higher nonunion rate and a greater number of weeks to union than fractures without this vascular injury. Poor outcomes (gangrene, amputation, or death) were associated with a Mangled Extremity Severity Score greater than or equal to 6.
Conclusion: Good early vascular repair, adequate stabilization of the fractures & early rehabilitation gives good results.