Update in combined musculoskeletal and vascular injuries of the extremities

Stéfanou, N.; Arnaoutoglou, Christina; Papageorgiou, Fotios; Matsagkas, Miltiadis; Varitimidis, Sokratis; Dailiana, Zoe

doi:10.5312/wjo.v13.i5.411

Cited by 3 publications

(4 citation statements)

References 110 publications

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“… 15 , 16 , 17 , 18 , 19 For civilian trauma it has been reported to be approximately 1.6% in adults and 0.6% in pediatric patients, significantly lower than that in war trauma (6% to 12%). 3 , 4 , 19 Young people, especially men, were reported to account for the majority of patients with extremity vascular injury, 3 , 20 , 21 which is consistent with the present study. Average age in our group was 44.1 ± 16.6, and 81.1% (43/53) patients were male.…”

Section: Discussionsupporting

confidence: 92%

Management of Suspected Peripheral Vascular Injuries in Orthopedic Trauma

Li,

Tian,

Fei

et al. 2024

Orthopaedic Surgery

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ObjectiveIn orthopedic trauma, identification of extremity trauma combined with vascular injury is challenging. Missed diagnosis may result in amputation or even death. The purpose of this study was to investigate whether physical examination combined with handheld vascular ultrasound Doppler examination could be an effective method of screening for peripheral vascular injury and to explore the characteristics of vascular injuries in orthopedic trauma patients.MethodsRetrospective analysis of patients in the emergency department of orthopedic trauma in our hospital from January 2022 to October 2023. Physical examination combined with handheld vascular ultrasound Doppler examination was used as a screening method for suspected vascular injuries. Patients with suspected vascular injury would undergo further angiography and receive multidisciplinary treatment. Angiography was used as the gold standard for diagnosing vascular injuries. Patient demographics, mechanism of injury, location and type of injury, angiographic results, surgical notes, and early treatment outcome data were recorded.ResultsA total of 55 cases (58 limb injuries) with suspected vascular injury were ultimately included. Angiography revealed that 53 cases (55 limbs, positive rate 94.8%) were considered to have confirmed vascular injuries. Forty‐three were male (81.1%) and 10 were female (18.9%), with mean age 44.1 ± 16.6 years. The main mechanism of injury was traffic accident (30, 56.7%). Most common site of vascular injuries was knee joint (30/55, 54.5%), and popliteal artery (23, 47.9%) was the most commonly injured blood vessel. After multidisciplinary collaborative treatment, overall patient mortality was 3.8% (2/53), and limb survival rate among surviving patients was 81.1% (43/53) in our study.ConclusionIn orthopedic trauma, “Hard signs” and “soft signs” combined with handheld vascular ultrasound Doppler examination were effective ways to screen for suspected vascular injuries. Most limbs had associated fractures or dislocations at the site of vascular injury. Collaboration of vascular surgery, microsurgery and orthopedic trauma may help improve patients' prognosis.

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Section: Discussionsupporting

confidence: 92%

Management of Suspected Peripheral Vascular Injuries in Orthopedic Trauma

Li,

Tian,

Fei

et al. 2024

Orthopaedic Surgery

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“…In general, when the vascular injury is located above the elbow, it is the first to be addressed since the time of limb ischemia is critical. Exception to this surgical sequence is when external fixation is required immediately to stabilize the limb after massive musculoskeletal trauma[ 6 ]. On the other hand, for forearm arterial injuries, orthopedic stabilization of associated bony injuries typically is performed before vascular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Even though there are some scores showing the way, e.g. MESS (MESSI) introduced by Johansen et al [ 29 ] in 1990, in our department we try to give a chance to salvage procedures except for cases of prolonged ischemia or inability to save the limb because of extreme abuse[ 6 , 29 ]. We strongly believe that the good results of our study are due to our adherence to clear diagnostic protocols for combined vascular and musculoskeletal injuries as well as the establishment of an algorithm for the sequential anatomical restoration of injured structures in these types of major and complex injuries of the upper extremity[ 6 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The patients were usually first evaluated at the emergency department or referred from the five hospitals of our health district, with a population of approximately one million people. The diagnosis was based on our department’s diagnostic algorithm for the management of vascular injuries in musculoskeletal trauma (Figure 1 in the study by Stefanou et al [ 6 ] Combined musculoskeletal and vascular injuries of the extremities) starting with clinical examination at first and the use of a doppler device. In the presence of hard signs for vascular injury no further imaging was needed, apart from few cases in which was necessary for medicolegal reasons, and the patient was taken to the operation room as soon as possible[ 7 ].…”

Section: Methodsmentioning

confidence: 99%

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Upper extremity vascular injuries: Etiology, management and outcome

Stefanou,

Mylonas,

Angelis

et al. 2024

World J Crit Care Med

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BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population. They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations. Their management is challenging since they can lead to disabilities with major socioeconomic effects. AIM To analyze data about the mechanism of injury, the management algorithm and functional outcomes of vascular injuries of the upper extremity. METHODS One hundred and fifteen patients (96 males and 19 females) with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted. Mean patients’ age was 33.7 years and the mean follow up time was 7.4 years. Patients with Mangled Extremity Severity Score ≥ 7 and Injury Severity Score ≥ 20, previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded, from the study. RESULTS A penetrating trauma was the most common cause of injury. The radial artery was the artery injured in most of the cases (37.4%) followed by the ulnar (29.5%), the brachial (12.1%) and the axillary (6%). A simultaneous injury of both of the forearm’s arteries was in 15.6% of the cases. In 93% of the cases there were other concomitant musculoskeletal injuries of the extremity. Tendon lacerations were the most common, followed by nerve injuries. The postoperative functional scores (full Disabilities of the Arm, Shoulder, and Hand and VAS) had very satisfactory values. CONCLUSION Although vascular injuries of the upper extremity are rare, they may occur in the context of major combined musculoskeletal trauma. Although a multidisciplinary approach is essential to optimize outcome, the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma, excluding isolated vascular injuries, ensures shorter operative times and better functional outcomes.

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Epidemiology of Traumatic Peripheral Vascular Injury in Patients Presenting at Tertiary Care Center of Nepal

Lamichhane¹

2023

NOAJ

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Introduction:Traumaticperipheralvascularinjuryremainsasignificantcauseofmorbidityandmortalityamongthegeneralpopula- tion. Majority of peripheral arterial injury are caused by a blunt trauma with a concomitant soft tissue injury and fractures requiring multidisciplinaryapproach.Despitemajoreffortsinestablishingprotocolsandguidelines,optimalstrategiesoftraumaticperipheral vascular injury are still under investigation and may vary depending upon the local setup and expertise available. The aim of this study was to identify the epidemiological profile of traumatic peripheral vascular injury presenting at tertiary care center of Nepal. Method: This is a retrospective study of patients who underwent vascular surgery in College of Medical Sciences Bharat- pur, from December 2018 and July 2021. Ethical approval was taken from the Institutional Review Committee of College of Medical Sciences (Registration Number 2020-081). Data for the study was retrieved from Emergency records, oper- ation records and medical record department of the hospital. A total of 63 cases of all age and sex were included in the study. Only patients having traumatic peripheral arterial injury and undergoing surgical intervention were included in the study. Patient data was initially tabulated using Microsoft Excel and analysis was done in SPSS software version 22.0. Result:Traumatic peripheral arterial injury was most commonly seen in 21-30 years (36.5%) age group with male preponderance (88.9%).Sharpinjurymechanismaccountedfor(42.9%),followedbyroadtrafficaccidents(41.3%).Upperlimbarterialinjurywasseenin 61.9% of patients and radial artery was the most common to be injured (34.9%). Associated tendon injury was seen in 63.5%, whereas nerveinjurywasseenin20.6%.Complicationswereseenin47.6%patientsandwoundinfectionwasthemostcommonailment(12.7%). Conclusion:Traumatic peripheral vascular injury has a male preponderance with road traffic incidents being the major mechanism of injury in Nepal. These injuries have a high rate of complications.

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Update in combined musculoskeletal and vascular injuries of the extremities

Cited by 3 publications

References 110 publications

Management of Suspected Peripheral Vascular Injuries in Orthopedic Trauma

Management of Suspected Peripheral Vascular Injuries in Orthopedic Trauma

Upper extremity vascular injuries: Etiology, management and outcome

Epidemiology of Traumatic Peripheral Vascular Injury in Patients Presenting at Tertiary Care Center of Nepal

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