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However. (brachial artery is pinched anteriorly in ͚cleft͛) Radial neck fracture May injure. Swelling is significant and may cause much of the neurovascular problem. the possibility remains for radial or ulnar artery damage. an injury so significant has the capacity to affect the large nearby neurovascular structures (ie brachial plexus and axillary artery Fractured surgical neck of Injures the axillary nerve and posterior circumflex humeral vessels as humerus they wind around the neck Humeral shaft Fracture Injures the radial nerve and profunda brachii vessels as they wind around the shaft Humeral supracondylar Results from a fall on the hand with elbow flexed. or ulnar and/or median nerve damage with marked displacement. rarely results in significant neurovascular injury. Medial epicondyle fracture also lacerates or stretches the nerve. with the vascular component requiring more immediate attention. The main problem however is the sharp end of the proximal fragment that may lacerate the median nerve and/or brachial artery.   Taken from Gerry Ahern͛s 3-D model The most important complication of limb injuries involve the neurovascular bundle. but significant displacement may affect the underlying subclavian artery and brachial plexus divisions Shoulder dislocation Injures the axillary nerve and the posterior circumflex humeral vessels as they pass underneath the capsule. Most complications occur where the neurovascular structures pass close to dislocatable joints and commonly fractured bones Upper Limb SC joint dislocation Occurs with high-energy impact and puts superior mediastinal structures at risk such as brachiocephalic veins and aortic arch branches Fractured clavicle Normally causes few complications. All significant limb injuries first require assessment of peripheral pulses. Colles fracture Surprisingly. However. displacing the distal fracture fragment posteriorly. potentially injuring the ulnar nerve. . compress or stretch the posterior interosseus nerve to the forearm extensor muscles Elbow dislocation Usually a posterior displacement that stretches the ulnar nerve as it passes around the medial epicondyle.

The tibial and common peroneal nerves are sometimes at risk Dislocated knee The tibia is usually displaced posteriorly on the femur with (limb threatening) popliteal artery compression. the poor blood supply to the skin over the subcutaneous tibial surface puts its viability at risk Dislocated ankle Usually results from a bimalleolar fracture and significantly affect both posterior tibial and dorsalis pedis vessels . Acetabular fragments may also lacerate the nerve Fractured shaft of femur Will tear the local perforating arteries and their large muscular branches causing large (potentially life-threatening) haemorrhage. However. Thus a fracture above the capsular attachment will likely cause avascular necrosis of the head (requiring a prosthesis) whereas a fracture below the capsular attachment (leaving the vessels attached) will simply require a dynamic hip screw Dislocated hip Posterior displacement will compress the sciatic nerve. The profunda femoris artery may also be torn Supracondylar femoral The attachment of gastrocnemius flex the distal fragment with fracture potential laceration of the femoropopliteal artery. The tibial and common peroneal nerves will be affected Fibular neck fracture The common peroneal nerve will be affected either by direct trauma or subsequent stretching and swelling Tibial shaft fracture Will usually not directly affect the tibial vessels unless significant displacement or swelling occurs.Lower Limb Fractured neck of femur Displacement of a fracture above the capsule attachment at the neck will tear the retinacular vessel supply to the head (which are mainly from the medial circumflex artery) Retinacular arteries The arteries supplying the femoral head mainly come from capsular vessels reflected back along the neck.