OrthoNet

Arterial Injury

- ischemia time of 6 hours is the cutoff: most limbs can be salvaged if revascularization occurs before this; after 8 hours, the amputation rate is between 72% and 90%
- intimal tear with subsequent development of thrombosis can lead to a picture of palpable pulses initially that disappear (delayed loss of pulse)
- children are particularly prone to ischemia and gangrene due to arterial spasm, a rare problem in adults.

Any diminution of pulse, even if the pulse is detectable by Doppler testing, pressure, or palpation,
should be considered abnormal.

- all major arterial injuries should be repaired; venous injuries are controversial
- autogenos vein grafting is preferred
- surgical shortening of the bone may facilitate vascular repair, and leg length can be dealt with later
- ideally, fracture stabilization should precede vascular repair - may require temporary shunting; this needs to be decided upon by the surgeons
- prophylactic fasciotomy is a good thing!

Doing angiography: the question of whether to do angiography or not depends on the perfusion status of the limb.
- If the limb is perfused adequately, and there is no rush to stabilize the bone, then do the angiogram
- If the limb is white and non-perfused, then you may as well assume the injury to the artery is at the level of the fracture and just get on with exposing it.
- If the limb is broken at a number of levels and you are unsure where the injury is, get the angio.