Management of Suspected Peripheral Vascular Injuries in Orthopedic Trauma.

Orthop Surg

Department of Orthopaedics & Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.

Published: July 2024

AI Article Synopsis

  • The study aimed to evaluate the effectiveness of physical examinations alongside handheld vascular ultrasound Doppler examination for detecting peripheral vascular injuries in orthopedic trauma patients, as missed diagnoses can lead to severe consequences like amputation or death.
  • Conducted over nearly two years, the research analyzed cases of suspected vascular injuries in an emergency orthopedic department, using angiography as the gold standard for confirming vascular injuries.
  • Results from 55 cases showed a 94.8% confirmation rate for vascular injuries, predominantly from traffic accidents, with knee joint injuries being most common; the study concluded that the combined assessment method can effectively identify these injuries and ultimately help improve patient outcomes.

Article Abstract

Objective: In orthopedic trauma, identification of extremity trauma combined with vascular injury is challenging. Missed diagnosis may result in amputation or even death. The purpose of this study was to investigate whether physical examination combined with handheld vascular ultrasound Doppler examination could be an effective method of screening for peripheral vascular injury and to explore the characteristics of vascular injuries in orthopedic trauma patients.

Methods: Retrospective analysis of patients in the emergency department of orthopedic trauma in our hospital from January 2022 to October 2023. Physical examination combined with handheld vascular ultrasound Doppler examination was used as a screening method for suspected vascular injuries. Patients with suspected vascular injury would undergo further angiography and receive multidisciplinary treatment. Angiography was used as the gold standard for diagnosing vascular injuries. Patient demographics, mechanism of injury, location and type of injury, angiographic results, surgical notes, and early treatment outcome data were recorded.

Results: A total of 55 cases (58 limb injuries) with suspected vascular injury were ultimately included. Angiography revealed that 53 cases (55 limbs, positive rate 94.8%) were considered to have confirmed vascular injuries. Forty-three were male (81.1%) and 10 were female (18.9%), with mean age 44.1 ± 16.6 years. The main mechanism of injury was traffic accident (30, 56.7%). Most common site of vascular injuries was knee joint (30/55, 54.5%), and popliteal artery (23, 47.9%) was the most commonly injured blood vessel. After multidisciplinary collaborative treatment, overall patient mortality was 3.8% (2/53), and limb survival rate among surviving patients was 81.1% (43/53) in our study.

Conclusion: In orthopedic trauma, "Hard signs" and "soft signs" combined with handheld vascular ultrasound Doppler examination were effective ways to screen for suspected vascular injuries. Most limbs had associated fractures or dislocations at the site of vascular injury. Collaboration of vascular surgery, microsurgery and orthopedic trauma may help improve patients' prognosis.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216823PMC
http://dx.doi.org/10.1111/os.14079DOI Listing

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