Introduction. Critical limb ischemia (CLI) is the reduced blood flow in the arteries of the lower extremities. It is a serious form of peripheral arterial disease, or PAD. If left untreated the complications of CLI will result in amputation of affected limb. The treatment experience of diabetic foot with transverse tibial transport was carried out by Ilizarov technique. Madura foot ulcer is not a common condition. It disturbs the daily activities of the patient. Pain swelling with multiple nodules with discharging sinus with discoloration(blackening) of the affected area is the main problem. Materials and Methods. We treated total case: 36 from Jan. 2003 – Jan. 2020 (17yrs.). Among these-. TAO- 20. Limb Ishchemia- 5. Diabetic Foot- 9. Mycetoma pedis- 2. Infected sole and dorsum of the foot- 5. Results. Transverse corticotomy and wire technique followed by distraction increases blood circulation of the lower limbs, relieving the pain. The cases reported here were posted for amputation by the vascular surgeons, who did not have any other option for treatment. Hence we, re-affirm that Academician Prof. Ilizarov's method of treatment does help some patients suffering from these diseases. Conclusions. By Ilizarov compression distraction device for TAO, modura foot ulcer, diabetic foot ulcer, mycetoma pedis ulcer, infected sole and dorsum of the foot ulcer were treated by introducing K/wires through the bones with proper vertical corticotomy. Application of this noble device will bring angeogenesis within the reach of all deserving patients

Thoracic Outlet Syndrome (TOS) is a complex of symptoms representing neurovascular compression in the supraclavicular area and shoulder girdle. Arterial thoracic outlet syndrome represents only 1% of all TOS's. We present two cases of arterial TOS's following internal fixation of clavicular fractures. Two cases of clavicular fractures managed with internal fixation and subsequently diagnosed with symptomatic, position dependent arterial occlusion are presented. The first case of a 16-year-old male treated with an intramedullary compression screw. He developed symptoms and was diagnosed with TOS using dynamic duplex examination performed by a vascular surgeon. Revision surgery was planned to decompress the subclavian artery from the hypertrophic callus at the fracture site. Before this could be performed the patient re-fractured his clavicle and bent the intramedullary screw. This resulted in resolution of the TOS symptoms. Following this second injury the patient went on to unite the fracture. The second case was of a 48-year-old male. He was initially treated non- operatively until the patient reported sensory and motor disturbances involving the hand and forearm. Excess callus was excised and the fracture was fixed using a locking plate. The symptoms improved, but worsened again eight weeks post operatively. Angiogram revealed vascular occlusion on arm abduction. Repeat surgery was performed in conjunction with a vascular surgeon. The plate was removed, vascular structures were released from fibrous tissue in the region of the fracture, and the posterior edge of the clavicle was debrided with a burr to reduce future impingement on vascular structures. Post operatively the TOS symptoms did not recur. Arterial thoracic outlet syndrome is an uncommon complication of trauma involving the clavicle. It can present in the presence or absence of surgical intervention, but can require surgical intervention to resolve

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