Two-team management of vascular injuries concomitant with osteo-articular injuries in 36 patients over six years.
BACKGROUND
Patients with both vascular and osteoarticular injuries require multidisciplinary management. Vascular injuries may be function- and/or life-threatening. The lower limbs are predominantly affected. Traffic, domestic, and work-related accidents contribute most of the cases. The primary objective of this study was to describe the management of patients with concomitant vascular and osteo-articular injuries, with special attention to the rates of amputation and fasciotomy. The secondary objective was to suggest a management sequence to optimise our surgical practice.


HYPOTHESIS
The management sequence is a crucial consideration in patients with both vascular and osteo-articular injuries.


MATERIAL AND METHODS
A 6-year, retrospective, observational study was conducted in patients with concomitant vascular and osteo-articular injuries.


RESULTS
The study included 36 patients with a mean age of 40.6±22.1 years. The main sources of injury were traffic accidents (n=19, 52.8%), crush injury (n=8, 22.2%), and falls (n=5, 13.9%). A compound fracture was present in 20 (55.6%) patients. Evidence of ischaemia in 25 (69.4%) patients, and bleeding in 11 (30.6%) patients. Pre-operative imaging, by ultrasonography or computed tomography, was performed in 27 (75.0%) patients. The lower limb was involved in 30 (83.3%) patients, who had osteoarticular injuries to the femur and leg combined with injury to the popliteal artery. Fasciotomy was performed in 11 (30.6%) patients and secondary amputation in 7 (19.4%) patients. The limb salvage rate was 80.6%. Median patient survival was 9.3 [0-74.8] months.


DISCUSSION
Coordinated work by two surgical teams is crucial to manage concomitant vascular and osteo-articular injuries. The management sequence must be defined clearly. Computed tomography angiography is the investigation of choice and should be performed at the slightest suspicion of vascular injury.


LEVEL OF EVIDENCE
IV, retrospective observational study.
['Leclerc|B|B|', 'Boyer|E|E|', 'Menu|G|G|', 'Leclerc|G|G|', 'Sergent|P|P|', 'Ducroux|E|E|', 'Salomon Du Mont|L|L|', 'Garbuio|P|P|', 'Rinckenbach|S|S|', 'Obert|L|L|']
D000293:Adolescent D000328:Adult D000368:Aged D000671:Amputation D000071938:Fasciotomy D005260:Female D005597:Fractures, Open D006470:Hemorrhage D006801:Humans D007511:Ischemia D007596:Joints D007869:Leg Injuries D023821:Limb Salvage D008297:Male D008875:Middle Aged D009104:Multiple Trauma D010348:Patient Care Team D011150:Popliteal Artery D012189:Retrospective Studies D014057:Tomography, X-Ray Computed D057772:Vascular System Injuries D055815:Young Adult
Vascular injury Osteoarticular injury Multi-team management