Presented

Presented by:
by:
Dr.
Dr. Joko
Joko Pranoto
Pranoto

Consultant:
Consultant:
Dr.
Dr. Reza
Reza Muhruzza
Muhruzza Putra
Putra Sp.OT
Sp.OT
 INTRODUCTION
• Adequate vascularity of the limb is needed for fracture union
• 2 goals of patient’s management with extremity arterial
injury:
1. Save the patient’s life
2. Save the patient’s extremity and the function of the limb
• Peripheral artery injuries occur 90% in the extremity
associated with fractures and dislocation
• Popliteal artery injuries are among the most challenging of
all extremity vascular injuries.
 MATERIAL AND METHODS
This prospective study was conducted in a tertiary
care hospital. 31 Patients admitted to emergency ward
with fractures and dislocation associated with vascular
injury was taken into this study.

Inclusion Criteria Exclusion Criteria

 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 and II ischemia,
• Mangled extremity severity score (MESS) ≤ 8.
 Exclusion Criteria

• Crush injury,
• Train traffic accident,
• Polytrauma patient (associated with abdomen and
chest injury),
• Class III ischemia,
• MESS score >8.
 RESULTS
• Mean Age : 30,9 YO (17-50 years)
• Sex majority : Male (29 Patients)
• Mode of injury: Road traffic accidents (RTA)  27 cases
(87%)
• Upper limb Fracture (5 cases) and lower limb Fracture
(26 cases)
• Closed fracture (10 cases) and open fracture (21 cases)
• Most common artery involved was Popliteal artery (21
cases)
 RESULTS
• Complication:
 Malunion (3 cases)
 Infection (10 cases open injuries (6 cases)
and close injururies (4 cases)
 Amputation: 5 patients AK amputation, 4 in
open injuries and 1 in closed injuries (4 due to
graft failure, 1 due to infection.
 1 patient was death
DISCUSSION (TABLE 1)
DISCUSSION (TABLE 2)
DISCUSSION (TABLE 3)
DISCUSSION (TABLE 4)
 DISCUSSION
Discussion
• The time of preoperative evaluation should be as
short as possible to minimize ischemic time and thus
prevent potential necrotic changes
• Early application of systemic anticoagulant therapy
(heparin, 100mg/kg iv)reduces amputation.
• Treatment of vascular trauma also includes
appropriated management of soft tissue injury.
Multiple debridements were needed in several of
patients to control infection.
 CONCLUSION
• Assessment of vascular injuries in fractures and
dislocation based on clinical examination and hand
Doppler reduces the assessment time than on imaging.
• Patients with Grade I, II, and III A injuries with vascular
injury, internal fixation are the ideal method to fix the
fracture.
• Delay in surgery and extensive soft tissue injury are
associated with increased amputation rate. Early
intervention prevents myonecrosis and its complication.
THANK YOU