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    Acute Vascular Injury

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    uaghug

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Acute Vascular Injury

    Uploaded by

    uaghug
    3 views3 pages

    Original Title

    Acute vascular injury

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    3 views3 pages

    Acute Vascular Injury

    Uploaded by

    uaghug

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Acute vascular injury: Initial assessment and management

    •Acute vascular injury is a potential orthopaedic emergency.

    Incidence
    Overall uncommon – 3% of long bone fractures
    Specific circumstances – Fractures with Gun Shot Wound (~38%)
    Knee dislocations (16-40%)
    Blunt trauma (15%)
    Iatrogenic (3%)
    Mechanism Of Injury
    • Penetrating trauma
    - Gun Shot Wound
    - Stab
    • Blunt trauma
    - High energy
    - Low energy
    • Iatrogenic

    Types Of Vascular Injuries


    • Laceration (complete/incomplete transection) – most common
    • Bleeding more severe in partially transected vessels
    • Complete transection results in retraction and vasoconstriction
    • Blunt trauma injures by crushing, distraction or shearing
    • Intimal flap may form
    -Thrombosis - Dissection - Rupture
    Thrombosis may propagate or embolize
    • A-V fistula

    Consequences Of Vascular Injuries


    • Blood loss • Ischemia •Compartment syndrome
    •Tissue necrosis •Amputation •Death
    If no intervention is done in time, irreversible damage occurs after 6 hours.

    Prognostic Factors
    • Level & type of vascular injury
    • Collateral circulation
    • Shock/hypotension
    • Tissue damage (crush injury)
    • Warm ischemia time
    • Patient factors/medical conditions

    Immediate Treatment
    • Control bleeding> Replace volume blood>
    Cover wounds> reduce fractures/dislocations>
    splint> re-evaluate.
    Diagnosis
    • Physical exam – most important
    - Major hemorrhage/hypotension - Arterial bleeding - Expanding hematoma
    - Altered distal pulses - Injury to anatomically related nerve
    - Temperature differential between extremities - Pallor

    • Pulse Oximetry
    - lower reading in one limb is suggestive but does not confirm or exclude vascular injury
    - Unhelpful

    • Doppler Ultrasound
    - presence of Doppler signal in a pulseless limb only gives false sense of security
    - Does not imply a less severe or urgent injury

    • Duplex Ultrasound
    - requires experience operator
    - Can detect intimal tears, thrombosis, pseudoaneurysm, AV fistula
    - Can be limited by hardware, dressing, pain.

    • Angiography
    - Locates site of injury, characterises injury &
    defines status of vessels(proximal & distal).
    - Limited by: expensive, time consuming, procedural risks &
    difficulty in monitoring issues.

    • Surgical exploration
    - Indicated for- Obvious arterial injury on exam, no doppler signal, site of injury apparent, prolonged
    warm ischemia time.

    Surgical considerations
    • who goes first? • Temporary shunts •Fracture stabilisation techniques •Salvage vs amputation
    • Fasciotomies

    Continued evaluation
    Vascular injuries are dynamic so, evaluation should continue after the initial injury or surgery about
    circulation, neurologic function & compartment pressures.

    Conclusion
    • uncommon
    • Potential risk of vascular injury with every orthopaedic injury
    • Most important for diagnosis
    - High index of suspicion
    - Thorough physical exam
    • Be aware of injuries associated
    • Understand signs/symptoms of arterial injury
    • Time is crucial
    • Have a defined protocol/relationship with your colleagues from vascular & trauma surgery.

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