Limb fracture with vascular compromise

What it is

A fracture may carry an injury of the artery with it, and that is what turns a bone injury into a limb injury. In the Gustilo classification of open fractures this is type IIIC: an open fracture associated with vascular injury that requires repair for limb preservation, and the peripheral artery pulse is absent.

Vascular injury sits among the local complications of a fracture, in the immediate window of hours to days and the early window of 2-12 weeks, beside visceral injury and nerve injury. The vessel is cut, torn, compressed or contused, either by the initial injury, or subsequently by swelling, bone fragments, reduction manoeuvres or surgery - so the treatment can cause it as well as the initial injury.

Three types are named:

• Laceration.
• Intimal, which is not obvious at the beginning, so the rule is to admit the patient.
• Spasm, because the artery was stretched.

The vessels drawn beside particular injuries are the femoral artery and the popliteal artery, and at the elbow the supracondylar fracture with the brachial artery and the anterior interosseous nerve; the acetabular fractures and hip dislocation go with the sciatic nerve.