Introduction: Vascular injuries associated with limb bone fractures are relatively uncommon.

Aim: To determine the mechanisms of injury and evaluate the outcome of combined orthopaedic and vascular injuries.

Method: A retrospective review of all patients with vascular injury associated with limb bone fractures between January 1992 and July 2006 was performed. Data collected included demographic details, clinical presentation, assessment, management and outcome.

Results: Of 22,340 fractures treated during the 14 years period 36 patients sustained a vascular injury that required surgical intervention. Of those, 18 patients (50%) had a concomitant fractures or other orthopaedic injury this group form the basis of the audit. The median age was 31.1 (range 3–80) years, and 66% were male.

Road traffic accidents accounted for 12 injuries (66%), other accidents 4(22%), iatrogenic injury 1(6%), and 1 gunshot injury (6%). Four patients had an associated nerve injury with varying severity. Skeletal fixation preceded vascular repair in most of the cases. Peroperative arterial shunting was not used in any patient. The primary vascular procedures included end-to-end anastamosis 2(11%), bypass grafting 1(6%), interposition vein grafts 8(43%), vein patch 1(6%), direct arterial repair 2(11%), ligation 2(11%), primary amputation 1(6%), reposition of normal course of artery 1(6%).

During a 17 months follow-up period, the upper and lower limb preservation rate was 100 and 89%, respectively. Nine patients (50%) were symptom free; three patients (16.6%) had a neurological deficit.

Conclusion: Vascular injury is uncommon in the orthopaedic patients. High suspicion and early intervention is essential to optimise outcome and function.

The study was designed to determine the incidence and to quantify the risk factors of permanently decreased bone mineral density (BMD) of the Lumbar spine and Femoral neck following tibial shaft fractures.

42 consecutive adults treated for isolated tibial shaft fractures at our institution between January 1984 and June 1985 formed the subjects of this study. Mechanism and type of injury, method of treatment, length of immobilisation and weight bearing status and healing time were determined from the patient records. A questionnaire including history of smoking, alcohol consumption, medications, other fractures, medical conditions like thyroid/parathyroid disorders, convulsions, and renal disorders was administered. Bone mineral density of lumbar 1–4 vertebrae and both hips was assessed using DEXA scanning. T and Z scores were generated. Statistical analysis was performed using the Chi square test to test the significance of association of osteopenia/osteoporosis (Z score < -1) with a previous tibial shaft fracture and calculating the odds ratio (OR) and 95% confidence interval (CI) to quantify the suspected risk factors.

The incidence of significant loss of BMD of the ipsilateral femur and/or lumbar spine was found to be 33%. A statistically significant association (p< 0.001) between a history of tibial shaft fracture and permanent loss of BMD was noted. The following risk factors were found to be statistically significant; Smoking (OR 22, 95% CI=4–> 40, p< 0.001), Alcohol more than 20 units/week (OR 11, 95% CI 2.2–54,p< 0.005), Open fracture (OR 17, 95% CI=2.9–> 40, p< 0.001), Non-weight bearing more than 12 weeks (OR 15, 95% CI 2.9–> 40, p< 0.005), and delayed union defined as healing time more than 6 months (OR 15, 95% CI 1.54–> 40, p < 0.05).

Permanent regional osteopaenia/osteoporosis occurs in a significant proportion of tibial shaft fracture patients. Modern fracture management should include identifying ‘at risk’ patients and appropriate management to prevent fragility fractures.