Principles in the management of arterial injuries associated with fractures/dislocations

Improved operative exposure of infrapopliteal vessels in combined vascular and orthopedic injuries

“…4 The third is the frequent use of four-compartment fasciotomy, s and the fourth is rigid stabilization of the bony structures so as not to disrupt the vascular repair. 6 Optimal timing and method of orthopedic fixation in these complex injuries continue to be controversial. Several authors have advocated primary vascular reconstruction before bony stabilization/ Others have proposed the additional use of a temporary vascular shunt to minimize ischemia time and allow maximal accessibility to injured vessels/However, this approach carries the risk of avulsion or further vascular injury during subsequent orthopedic manipulation.…”