Abstract
It is the prime responsibility of the treating surgeon to identify and treat the vascular injury along with the skeletal trauma. Limbs with combined Orthopaedic and Vascular injuries are traditionally admitted as an Orthopaedic emergency.
In a 17 year period we treated 67 cases of vascular injuries (including 16 pseudo aneurysms) associated with fractures and dislocations or soft tissue injuries of the limbs. Three cases have been followed up for over 20 years. All patients were operated by Orthopaedic residents on duty with limited resources, without the help of vascular surgeons. We relied on clinical diagnosis and immediate exploration of the blood vessels rather than time consuming procedure of arteriography. Skeletal stabilisation was achieved by internal or external fixation. Vascular reconstruction involved end to end repair or vein grafting. Fasciotomy was performed in selected cases where the injury-revascularisation time was more than 6 hours. Post-operative care involved limb placement at body level, Sympathetic blockade for 48 hours, vasodilators, Lomodex, Mannitol, Aspirin and antibiotic therapy. Urine was monitored for smoky color indicating myoglobinuria.
Though only 17 were repaired within six hours, limb viability with good function was obtained in 51 cases. Complications included 7 deaths, 6 amputations, 2 acute renal failures and delayed occlusion in one case.
