Vascular Injuries Associated w/ Tibial Fractures
- Vascular Trauma Associated w/ Fractures (main dissucssion);
- Technique of Microanatomosis:
- anterior tibial artery occlusion:
- most common site of vascular injury;
- occlusion occurs as anterior tibial artery passes from behind thru interosseous membrane;
- occlusion may cause loss of anterior compartment muscles, even if posterior tibial artery remains patent;
- compartment syndrome of anterior compartment is common even if diastolic blood pressure is normal;
- lower leg usually can survive loss of either peroneal artery or posterior tibial artery;
- it is much less common for posterior tibial artery to be injured w/ frxs of tibia;
- however, injury to this artery may occur w/ compartment syndromes esp, when an inadequate
fasciotomy is performed (one that does not specifically adress the deep compartment;
- presence of dorsalis pedis pulse does not r/o injury to ATA, since there may be retrograde blood flow from posterior tibial artery;
- blood is shunted from the posterior tibial artery to the peroneal artery and then to the dorsalis pedis pulse;
- while pulses are usually present in compartment syndromes, the absence of a pulse (eg. from
associated fracture or trauma) raises the probability that a compartment syndrome could occur;
- for instance loss of the anterior tibial artery following a tibial fracture, places the anterior compartment at high risk for compartment syndrome
The Severely Traumatized Lower Limb: Reconstruction versus Amputation--Symposium: Vascular Injury Associated With Fracture-Dislocations of the Lower Extremity.
The Severely Traumatized Lower Limb: Reconstruction versus Amputation--Symposium: Limb Reconstruction versus Amputation Decision Making in Massive Lower Extremity Trauma.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, August 1, 2012 2:08 pm