Author(s): Karavias D, Korovessis P, Filos KS, Siamplis D, Petrocheilos J,
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Abstract Seventeen patients, aged 11-67 years (mean, 32.6), with major vascular injuries associated with traumatic orthopaedic injuries, were treated operatively in the authors' institution over a 4-year period. The most common mechanism of trauma was a high-energy injury (70.8\%), and the rate of open injuries was 88.2\%; 64.9\% of the injuries were located in the lower extremities. The treatment protocol consisted of aggressive resuscitation; Doppler imaging and, when necessary, angiography; stable bone fixation with subsequent vascular repair; and extended wound debridement. The vascular repair for arterial lacerations consisted of (a) end-to-end anastomosis (47.2\%); (b) interpositional homologous vein graft (23.6\%); (c) vascular decompression through fracture distraction in one patient (5.9\%); (d) xenograft interposition (in one patient; 5.9\%); (e) venous repair (in three patients; 17.7\%); and (f) embolectomy (in all patients). Three vascular reoperations (17.7\%) were necessary because of rupture of the anastomosis. The authors' preferred bone stabilization method was external fixation, which was used in 47.2\% of cases. Amputation was performed in three cases (17.7\%) as a salvage operation. Although six patients (35.4\%) were admitted with delayed shock (mean duration, 73.6 +/- 27.8 min), this led to a lethal outcome due to shock lung in only one patient. Another patient developed massive lung embolism 3 months postoperatively and died. The authors believe that this well-organized approach, based on a specific treatment protocol, for patients with severe orthopaedic trauma and concomitant vascular injury, not only improves outcome but gives good to excellent functional results in the majority of patients.
This article was published in J Orthop Trauma
and referenced in Orthopedic & Muscular System: Current Research