Vascular injury with associated bone and joint trauma

Meek, A C; Robbs, J V

doi:10.1002/bjs.1800710507

Cited by 21 publications

(7 citation statements)

References 12 publications

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“…In clinic, the pulse of dorsal pedal artery can still be felt in some TPF patients with PAI in the early stage. Meek [17] et al found that the weaker pulse than normal can be felt at the distal end in about 22% of patients with injury of major limb arteries, also consistent with the ndings in this study that the weaker pulse of dorsal pedal artery than that at the contralateral side could be felt in 5 cases in the early stage. The possible reason is that the popliteal artery has not been completely ruptured but severely contused in some patients with PAI, causing damage to the artery intima and thrombosis, so some blood supply remains in the initial stage.…”

Section: Discussionsupporting

confidence: 92%

Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

Yao¹,

Wu²,

Wu³

et al. 2020

Preprint

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Objective To explore the association between the classification for tibial plateau fractures (TPF) and the popliteal artery injury (PAI).Methods 22 TPF patients accompanied by PAI who were treated from May 2012 to July 2019 were retrospectively analyzed. There were 19 males and 3 females with an average age of 49.43 years. The Schatzker classification and three-column classification were performed for TPF. The severity of extremity injury was evaluated using the mangled extremity severity score (MESS). Except 3 patients treated with amputation, the remaining patients underwent surgical repair of popliteal artery and fracture external fixation. The efficacy was evaluated using the Rasmussen score for tibial head fractures.Results There were 10 cases of Schatzker type IV fractures, 1 case of type V fractures and 11 cases of type VI fractures. Based on the three-column classification, the posterior column was involved in 22 cases, 2 columns in 15 cases and 3 columns in 6 cases. The MESS was 6-10 points, with an average of 7.59 points. Except 1 case directly receiving amputation, 3 cases of segment P1 injury was observed via preoperative DSA + intraoperative exploration, while segment P2 in 6 cases and segment P3 in 12 cases. Popliteal artery was found completely ruptured in 11 cases, partially ruptured in 1 case, and severely contused with thrombosis in 10 cases. The Rasmussen score was given to 19 patients at the last follow-up,except for the cases undergoing amputation. The efficacy was excellent in 8 cases, good in 7 cases, moderate in 3 cases and poor in 1 case.Conclusion: In patients with complex TPF, the risk of PAI becomes higher with the increase of Schatzker classification level. Knee CT scan is helpful in determining the severity of fractures and evaluating PAI. Based on the three-column classification, PAI should be suspected when the fractures involve the medial and posterior column.PAI is mainly in the segment P3, and artery rupture or severe contusion with extensive thrombosis may occur.The postoperative knee function of patients with complex TPF can be well restored by early active surgical repair of popliteal artery.

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Section: Discussionsupporting

confidence: 92%

Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

Yao¹,

Wu²,

Wu³

et al. 2020

Preprint

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“…In clinic, the pulse of dorsal pedal artery can still be felt in some TPF patients with PAI in the early stage. Meek [13] et al found that the weaker pulse than normal can be felt at the distal end in about 22% of patients with injury of major limb arteries, also consistent with the ndings in this study that the weaker pulse of dorsal pedal artery than that at the contralateral side could be felt in 5 cases in the early stage. The possible reason is that the popliteal artery has not been completely ruptured but severely contused in some patients with PAI, causing damage to the artery intima and thrombosis, so some blood supply remains in the initial stage.…”

Section: Discussionsupporting

confidence: 92%

Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

Yao¹,

Wu²,

Wu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background To explore the association between the classification for tibial plateau fractures (TPF) and the popliteal artery injury (PAI).Methods 22 TPF patients accompanied by PAI who were treated from May 2012 to July 2019 were retrospectively analyzed. There were 19 males and 3 females with an average age of 49.43 years. The Schatzker classification and three-column classification were performed for TPF. The severity of extremity injury was evaluated using the mangled extremity severity score (MESS). Except 3 patients treated with amputation, the remaining patients underwent surgical repair of popliteal artery and fracture external fixation. The outcome was evaluated using the Rasmussen score for tibial head fractures.Results There were 10 cases of Schatzker type IV fractures, 1 case of type V fractures and 11 cases of type VI fractures. Based on the three-column classification, the posterior column was involved in 22 cases, 2 columns in 15 cases and 3 columns in 6 cases. The MESS was 6-10 points, with an average of 7.59 points. Except 1 case directly receiving amputation, 3 cases of segment P1 injury was observed via preoperative DSA + intraoperative exploration, while segment P2 in 6 cases and segment P3 in 12 cases. Popliteal artery was found completely ruptured in 11 cases, partially ruptured in 1 case, and severely contused with thrombosis in 10 cases. The Rasmussen score was given to 19 patients at the last follow-up, except for the cases undergoing amputation. The outcome was satisfied in 14 cases, unsatisfied in 5 cases.Conclusion: In patients with complex TPF, the risk of PAI becomes higher with the increase of Schatzker classification level. Knee CT scan is helpful in determining the severity of fractures and evaluating PAI. Based on the three-column classification, PAI should be suspected when the fractures involve the medial and posterior column.PAI is mainly in the segment P3, and artery rupture or severe contusion with extensive thrombosis may occur.

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“…Compound fractures are usually associated with extensive soft tissue damage and significant interruption of collateral circulation, which increases the risk of critical ischemia, infection, and limb loss. 26 In this series, explosive injuries carried the highest risk of amputation. These injuries are usually associated with significant soft tissue damage and are more likely to affect the arterial supply at more than one level.…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Civil and War Peripheral Arterial Trauma: Review of Risk Factors Associated with Limb Loss

Davidović

Činara²,

Ille³

et al. 2005

Vascular

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We sought to analyze the early results of civil and war peripheral arterial injury treatment and to identify risk factors associated with limb loss. Between 1992 and 2001, data collected retrospectively and prospectively on 413 patients with 448 peripheral arterial injuries were analyzed. Of these, there were 140 patients with war injuries and 273 patients with civil injuries. The mechanism of injury was gunshot in 40%, blunt injury in 24%, explosive trauma in 20.3%, and stabbing in 15.7% of the cases. The most frequently injured vessels were the femoral arteries (37.3%), followed by the popliteal (27.8%), axillary and brachial (23.5%), and crural arteries (6.5%). Associated injuries, which included bone, nerve, and remote injuries affecting the head, chest, or abdomen, were present in 60.8% of the cases. Surgery was carried out on all patients, with a limb salvage rate of 89.1% and a survival rate of 97.3%. In spite of a rising trend in peripheral arterial injuries, our total and delayed amputation rates remained stable. On statistical analysis, significant risk factors for amputation were found to be failed revascularization, associated injuries, secondary operation, explosive injury, war injury (p < .01) and arterial contusion with consecutive thrombosis, popliteal artery injury, and late surgery (p < .05). Peripheral arterial injuries, if inadequately treated, carry a high amputation rate. Explosive injuries are the most likely to lead to amputations, whereas stab injuries are the least likely to do so. The most significant independent risk factor for limb loss was failed revascularization.

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Vascular injury with associated bone and joint trauma

Cited by 21 publications

References 12 publications

Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

Civil and War Peripheral Arterial Trauma: Review of Risk Factors Associated with Limb Loss

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