1: J Am Coll Surg  1996 Oct;183(4):377-83 

Changing patterns of arterial injuries associated with fractures and
dislocations.

Atteberry LR, Dennis JW, Russo-Alesi F, Menawat SS, Lenz BJ, Frykberg ER.

Department of Surgery, University of Florida Health Science Center at
Jacksonville 32209, USA.

BACKGROUND: Significant changes occurred over a 4.5-year period in the causes,
diagnosis, and treatment of arterial injuries associated with skeletal fractures
of the extremities. STUDY DESIGN: The trauma registry data of 1,091 consecutive
patients with fractures, dislocations, or both, were reviewed for the diagnosis
of associated arterial injury documented by arteriography or an exploratory
operation. The decision to perform a vascular repair was based solely on the
presence of definitive signs of arterial injury found during physical
examination. RESULTS: Arterial injuries occurred in 41 patients (3.8 percent).
Of these, 29 (71 percent) had penetrating injuries, and 12 (29 percent) had
blunt trauma. Twenty-six patients (63 percent) had definitive signs of arterial
injury and all required arterial repairs. Only three patients (7.3 percent), all
with blunt injuries, required amputations because of massive soft tissue trauma.
Fifteen patients had intimal flaps, irregularities, or localized narrowings
shown on the arteriogram. No patient's condition had deteriorated by the time of
a repeat arteriogram (n = 6) or physical examination (n = 9), and no injury
required delayed repair (mean follow-up of 6.5 months). No patient without
definitive signs of vascular injury at the time of initial examination required
surgical repair. CONCLUSIONS: Arterial injuries associated with fractures
increasingly result from penetrating trauma and carry a much lower risk of
amputation than injuries from blunt trauma. Physical examination can accurately
detect 100 percent of the arterial injuries requiring repair. Minimal arterial
abnormalities seen on arteriograms may be safely followed up by observation.

PMID: 8843267 [PubMed - indexed for MEDLINE]