Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity

Badash, Ido; Burtt, Karen E.; Leland, Hyuma A.; Gould, Daniel J.; Rounds, Alexis D.; Azadgoli, Beina; Patel, Ketan M.; Carey, Joseph N.

doi:10.1177/000313481708301030

Cited by 12 publications

(18 citation statements)

References 8 publications

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“…8 However, certain fracture patterns have demonstrated a propensity for vascular compromise including open fracture, tibial-fibula fracture, comminuted tibial plateau fracture, severely displaced fractures, and segmental shaft fractures, as well as patients presenting with blunt trauma, crushed injury, floating joint, and dislocation. 9 Vascular injury associated with blunt fractures in the lower extremity can be devastating carrying notable morbidity and mortality, with higher rates of complication than penetrating vascular injuries. 9 Acute limb ischemia after a vascular injury and lower extremity fractures can result in reperfusion injury, soft-tissue necrosis, and amputation.…”

Section: Etiologymentioning

confidence: 99%

“…9 Vascular injury associated with blunt fractures in the lower extremity can be devastating carrying notable morbidity and mortality, with higher rates of complication than penetrating vascular injuries. 9 Acute limb ischemia after a vascular injury and lower extremity fractures can result in reperfusion injury, soft-tissue necrosis, and amputation.…”

Section: Etiologymentioning

confidence: 99%

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Assessment and Interventions for Vascular Injuries Associated With Fractures

Spitler

Patch

McFarland

et al. 2022

J Am Acad Orthop Surg

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Vascular injuries associated with fractures are limb-threatening injuries with notable morbidity. The prompt and thorough evaluation of these patients is imperative to diagnose vascular injuries, and coordinated multidisciplinary care is needed to provide optimal outcomes. The initial assessment includes a detailed physical examination assessing for hard and soft signs of arterial injury, and the arterial pressure index can be used to reliably identify vascular compromise and the need for additional assessment or intervention. Advanced imaging in the form of CT angiography is highly sensitive in additional characterization of the potential injury and can be obtained in an expedient manner. The optimal treatment of fractures with vascular injuries includes providing skeletal stability and confirming or reestablishing adequate distal perfusion as soon as possible. Options for vascular intervention include observation, ligation, direct arterial repair, vascular bypass grafting, endovascular intervention, and staged temporary shunting, followed by bypass grafting. Although the optimal sequence of surgical intervention remains an incompletely answered question, the orthopaedic role in the care of patients with these injuries is to provide mechanical stability to the injured limb to protect the vascular repair and surrounding soft-tissue envelope.

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Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Assessment and Interventions for Vascular Injuries Associated With Fractures

Spitler

Patch

McFarland

et al. 2022

J Am Acad Orthop Surg

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show abstract

“…Complicated fractures can be limb-threatening if the arterial ow is reduced because of swelling, trauma, or compression. Arterial injuries have resulted in signi cant complications for patients with lower extremity fractures requiring ap coverage; however, limb salvage is still effective in most cases [3].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

Aydogan

Langer

Josten

et al. 2020

Preprint

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Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage.Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after one year.Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

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“…Complicated fractures can be limb-threatening if the arterial flow is reduced because of swelling, trauma, or compression. Arterial injuries have resulted in significant complications for patients with lower extremity fractures requiring flap coverage; however, limb salvage is still effective in most cases [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

Aydogan¹,

Langer²,

Josten³

et al. 2020

BMC Musculoskelet Disord

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Background Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores. Results We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

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Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity

Cited by 12 publications

References 8 publications

Assessment and Interventions for Vascular Injuries Associated With Fractures

Assessment and Interventions for Vascular Injuries Associated With Fractures

Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

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