Isolated Blunt Vascular Injury Following Motor Scooter Handlebar Impact: A Systematic Review

Abstract

All four patients who had arterial ligation performed proximal to the inguinal ligament were critically ischemic after ligation while when the level of ligation was below the inguinal ligament 14 out of 16 patients were compensated (significant).Pedal doppler flow signal was detected in ten patients only intraoperatively. However, four more patients regained Doppler signal in the ward few hours after the operation. All 14 patients with Doppler signal were compensated and required no further revascularization for limb salvage till discharge from hospital.In compensated patients the mean pre-operative ABI was 0.88 and the mean post-operative ABI was 0.49 with an average ABI drop of 0.39. However, in patients who required revascularization or amputation, the mean preoperative ABI was 0.83 and the mean post-operative ABI was 0.00 with an average ABI drop of 0.83 Conclusion -In drug addicts with infected femoral pseudoaneurysms, arterial ligation with local debridement without revascularization salvaged 70% of limbs in our study. The detection of pedal Doppler flow after ligation can stratify patients in whom revascularization might not be required for limb salvage. Additionally all efforts should be made to ligate the femoral artery below the inguinal ligament to preserve important juxta-inguinal collateral branches that can have great impact on limb outcome after ligation.

Comparison of two bicycle handlebar trauma cases

“…We believe that a low suspicion threshold for internal injury is warranted on learning the mechanism of injury and that all patient subtypes are at risk if they have sustained an injury of this fashion. Most of the vascular traumas associated with a handlebar injury involve the femoral artery or EIA9 14; this is significant as injury to the CFA has been found to be a key predictor of mortality in patients presenting with femoral vessel injuries 15…”

“…Bicycle handlebars are a known cause of both visceral2–4 and vascular trauma 5–8. While rare in occurrence, most vascular traumas associated with this mechanism of injury involve the common femoral artery (CFA) or external iliac artery (EIA) 9. To our knowledge, venous trauma stemming from handlebar trauma has only been reported three times,10–12 and this is the first case report to feature a patient experiencing complete destruction to both the CFA and the CFV due to handlebar trauma.…”

“…To our knowledge, venous trauma stemming from handlebar trauma has only been reported three times,10–12 and this is the first case report to feature a patient experiencing complete destruction to both the CFA and the CFV due to handlebar trauma. This is an uncommon mechanism of injury and is frequently missed on the initial presentation,9 with potentially catastrophic injuries if unattended. Collaborative work with surgeons and radiology enabled the right course of intervention in both cases.…”

Progressive Arterial Insufficiency in a Displaced Salter-Harris Type 1 Distal Femoral Fracture

“…This is usually seen after blunt trauma where an intimal flap may progress over time to cause complete arterial occlusion. Therefore, initial pulse examination, presumably, can be a fallible indicator 7 . Bishara et al 1 noted that typical signs of vascular injury were missing in up to 40% of patients.…”