Functional outcome analysis of long bone fractures and dislocation with vascular injury

Bala Subramanian, G (2013) Functional outcome analysis of long bone fractures and dislocation with vascular injury. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Trauma frequently involves the bones of the extremities. This can also involves the vessels of the extremities either directly from the initial injury or secondarily from the fragments of the fractured bone. The successful management of patients with lower extremity arterial injuries has two goals. The first is to save the patient’s life and the second is to save the extremity and the function of the limb. Popliteal artery injuries are among the most challenging of all extremity vascular injuries. The outcome depends predominantly on the force of injury. The popliteal vein and popliteal nerve are frequently involved associated injuries with popliteal artery. Popliteal artery (20% to 60%)10 is at risk during traumatic dislocation of the knee owing to the bowstring effect across the popliteal fossa secondary to proximal and distal thethering. AIMS AND OBJECTIVES : Aim of this study was to evaluate ; • The pattern of fractures and dislocations associated with vascular injury of extremities at our institution. • Outcomes of fracture union, function of the limb and complications in relation to fracture pattern and modality of treatment. MATERIALS AND METHODS: This was a prospective study conducted at Rajiv Gandhi Government General Hospital from August2011 to September 2012. Study has been conducted in thirty one patients. 31 Patients admitted in emergency ward with fractures and associated with vascular injury was taken into this study. The study was approved by the ethic al committee of the hospital and informed consent has been obtained from the patient. All patients has been taken up for surgical intervention both for vascular repair by vascular surgeons and skeletal fixation by us. Wounds were classified into open and closed. For Grade IIIA &III B wounds plastic surgeon opinion and if needed intervention has been done. Inclusion Criteria - Age >18 years, Fracture of femur, tibia, humerus, radius and ulna with vascular injury Knee and elbow dislocation with vascular injury, Class I&II ischemia, MESS score ≤ 8. Exclusion Criteria - Crush injury, Train traffic accident, Poly trauma patient (associated with abdomen and chest injury), Class III ischemia, MESS score > 8. RESULTS: 5 patients had above knee amputation after vascular repair. It was done in 4 patients with open injuries and 1 with closed injuries. 4 due to graft failure and 1 due to infection. Amputation rate was 16%. 4 cases presented late with more than 10 hours duration between injury and repair. Also gross soft tissue loss was present. There was 1 death due to crush syndrome. Reverse Saphenous vein graft was the vascular repair done in 27 cases. There was a mean hospital stay of 4 months with open grade III injuries. CONCLUSION: 1. Assessment of vascular injuries in fractures and dislocation based on clinical examination and hand Doppler reduces the assessment time than on imaging. 2. Patients with Grade I,II & IIIA injuries with vascular injury internal fixation is the ideal method to fix the fracture. 3. Initial management with external fixation allows time to assess the viability of limb, edema to subside and soft tissue to recover. 4. Delay in surgery and extensive soft tissue injury are associated with increased amputation rate. 5. In closed injuries with stable fracture can be stabilised through the same approach undertaken for vascular repair 6. Earlier rehabilitation reduces joint stiffness and improves muscle power. 7. Early intervention prevents myonecrosis and its complication.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome analysis ; long bone fractures ; dislocation ; vascular injury.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 03:29
Last Modified: 14 Sep 2017 03:29

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